







LIBRARY OF CONGRESS. 


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Shelf _ i _E3L.£ Q> 


UNITED STATES OF AMERICA. 







OBSTETRIC NURSING 



FULLERTON. 



BY THE SAME AUTHOR. 

NURSING IN 

ABDOMINAL SURGERY 

AND 

DISEASES OF WOMEN. 

SECOND EDITION, REVISED. 

12mo. 300 Pages. 70 Illustrations. Cloth, $1.50. 



\* The immediate success of Dr. Fullerton's " Handbook of Obstetric 
Nursing," a fourth edition of which has just been published, has encouraged 
her to prepare this manual on another and very important branch of the 
science and art of nursing. Dr. Fullerton has demonstrated that she not 
only knows what to say, but that she has the happy faculty of saying it in 
a plain, practical style that interests as well as instructs. 

Synopsis of Contents. — The Surgical Nurse — The Germ Theory of 
Disease — Asepsis and Antisepsis — Abdominal Section — The Preparation of 
the Room — The Preparation of Sponges — Sterilization of Instruments, etc. 
— Preparation of the Patient — Preparation of Operator and Assistants — 
The Nurse's Duties During Operation — The Nurse's Duties After Oper- 
ation and During Convalescence — Management of Complications — The 
Pelvic Organs in Women — Diseases of Women — -General Nursing in Pelvic 
Diseases — Preparations for Gynecological Examinations — Preparation for 
Gynecological Operations — Preparation of Patient, Operator, and Assist : 
ants — Duties of Nurse During Operation — Special Nursing in Gynecologi- 
cal Operations — Diet for the Sick. 

From The Bulletin of Johns Hopkins Hospital. — "An excellent text-book for 
nurses. * * * The style is pleasant and readable. * * * Such an attempt to 
occupy a new field so successfully carried out is most praiseworthy." 

From the Philadelphia Medical News. — " Dr. Fullerton has clearly discerned 
the requirements in the training of nurses for this special work, namely, the inculcation 
of knowledge that will give an intelligent idea of the work before them and the insistence 
upon habits of promptness and forethought. For both the physician and nurse this 
book presents the important points in a clear and impressive way." 

P. BLAKISTON, SON & CO., Publishers, Philadelphia. 



A HANDBOOK 



OF 



OBSTETRIC NURSING 



FOR 



NURSES, STUDENTS, AND MOTHERS. 



COMPRISING THE COURSE OF INSTRUCTION IN OBSTETRIC 

NURSING GIVEN TO THE PUPILS OF THE TRAINING 

SCHOOL FOR NURSES CONNECTED WITH THE 

WOMAN'S HOSPITAL OF PHILADELPHIA. 



\/ BY 

ANNA M. FULLERTON, M.D., 

PHYSICIAN IN CHARGE OF, AND OBSTETRICIAN, GYNECOLOGIST, AND SURGEON TO, TH] 
WOMAN'S HOSPITAL OF PHILADELPHIA; CLINICAL PROFESSOR OF GYNE- 
COLOGY IN THE WOMAN'S MEDICAL COLLEGE OF PENNSYLVANIA. 



FOURTH REVISED EDITION. ILLUSTRATED. 






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PHILADELPHIA : */ff%{ 

P. BLAKISTON, SON & C®0 C^ 

IOI2 WALNUT 'STREET. 
1895. 






Copyright, 1895, BY Anna M. Fullerton, M.D. 



PRESS OF WM F. FEU. <t CO,, 

1220-24 SANSOM STREET, 

PHILADELPHIA. 



TO 
Dr. ANNA E. BROOMALL, 

PROFESSOR OF OBSTETRICS IN THE WOMAN'S MEDICAL COLLEGE 
OF PENNSYLVANIA, 

ATTENDING OBSTETRICIAN AND GYNECOLOGIST, 

AND FORMER PHYSICIAN-IN-CHARGE, 

OF THE 

WOMAN'S HOSPITAL OF PHILADELPHIA, 

THIS VOLUME 
IS AFFECTIONATELY DEDICATED. 



PREFACE TO FOURTH EDITION. 



The excellent results to be attained by an adherence 
to the methods advocated in this little book, and ob- 
served in the obstetric work of the Woman's Hospital, 
will prove the value of cleanliness, antisepsis, and eternal 
vigilance on the part of the nurse, in averting the dan- 
gers of childbirth and reducing the mortality of early 
infancy. In this, as in former editions of my work, I 
have made every effort to bring its teachings up to the 
requirements of modern practice. An especial effort has 
been made to consider in detail the needs of the young 
infant whose hold on life in the earlier days of its exist- 
ence is slender. 

The grave responsibilities so often thrown upon the 
trained nurse, necessitate a most thorough knowledge 
upon her part of the conditions she may be called upon 
to manage. It is for her chiefly that this little book has 
been written. 

The importance, however, of a thorough understand- 

ix 



X PREFACE TO FOURTH EDITION. 

ing of the many little details of scientific nursing on 
the part of the physician leads me to trust that the 
work may be of value to physician as well as nurse ; 
and since both of these must have the entire support, 
sympathy, and assistance of the patient in their efforts 
for her well-being, the directions herein given as to pre- 
parations to be made, and rules of action to be observed, 
will, it is hoped, enable the patient to work in harmony 
with those who are working for her good. 



ANNA M. FULLERTON. 



Woman'' s Hospital of Philadelphia, 
September, 1895. 



CONTENTS 



CHAPTER I. 

PAGE 

The Pelvis and Genital Organs, 17 

CHAPTER II. 
Signs of Pregnancy, 25 

CHAPTER III. 
Management of Pregnancy, 32 

CHAPTER IV. 
Accidents of Pregnancy, 51 

CHAPTER V. 
Germs and Antisepsis, 57 

CHAPTER VI. 
Application of Antisepsis to Confinement Nursing, 64 

CHAPTER VII. 
Preparations for the Labor, . .' 75 

CHAPTER VIII. 

Signs of Approaching Labor, and the Process *of Labor, 86 

xi 



Xll CONTENTS. 

CHAPTER IX. PAGE 

Duties of the Nurse During Labor, 92 

CHAPTER X. 
Accidents and Emergencies of Labor, . 109 

CHAPTER XL 
Management of the Lying-in, 127 

CHAPTER XII. 
Care of the New-born Infant, 164 

CHAPTER XIII. 
Characteristics of Infancy in Health and Disease, 198 

CHAPTER XIV. 
Ailments of Early Infancy, 210 



LIST OF ILLUSTRATIONS 



FI G. PAGE 

1. Normal Pelvis, 18 

2. External Genitalia, 19 

3. Cavity of Uterus and Fallopian Tubes, 21 

4. Abdominal Belt, • • 35 

5. Spiral Reverse Bandage of Lower Extremity, 38 

6. Nipple Protector, 42 

7. Jenness-Miller Chemilette, 43 

8. Jenness-Miller Divided Skirt, 43 

9. Union Undergarment, 44 

10. Jenness-Miller Leglette, 44 

11. The Equipoise Waist, 46 

12. Occlusion Dressing (Dr. Garrigues'), 77 

13. Nightingale Wrap, 79 

14. Sylvester's Method of Resuscitation (First Movement), .... 112 

15. Sylvester's Method of Resuscitation (Second Movement), ... 113 

16. Schultze's Method of Resuscitation (First Movement), .... 115 

17. Schultze's Method of Resuscitation (Second Movement), ... 116 

18. Prochownick's Method of Resuscitation, 117 

19. Prochownick's Method of Resuscitation, . . 117 

20. Position of Patient in Hemorrhage after Labor, 123 

21. Nipple Shield, 140 

22. Variously Shaped Nipples, 141 

23. Figure-of- Eight Bandage of One Breast, 142 

24. Figure- of- Eight Bandage of Both Breasts, 143 

25. Garrigues' Breast Bandage, 144 

26. Breast Pump, 145 

xiii 



XIV LIST OF ILLUSTRATIONS. 

FIG. PAGE 

27. Handkerchief Bandage of Breast, 146 

28. Worcester's Y-Bandage, 148 

29. Obstetric Breast Support, ......... 149 

30. Home-made Bath-tub and Crib, 172 

31. The Lactometer, >. 178 

32. Sterilizer (Dr. Louis Starr), 191 

33. Graduated Nursing Bottle (Dr. Louis Starr), . . 194 

34. Rubber Nipple (Starr), 195 

35. Diagram Showing Eruption of Milk Teeth, 208 

36. Tarnier's Couveuse, 212 

37. Auvard's Couveuse (Interior View), 215 

^S. Auvard's Couveuse (Exterior View), 216 

39. Swaddled Baby, 217 

40. Single bulb Syringe (Starr), 230 



OBSTETRIC NURSING 



CHAPTER I. 
THE PELVIS AND GENITAL ORGANS. 

The Pelvis is that part of the skeleton found between 
the lower end of the spinal column and the thigh bones. 
It consists of four bones, the sacrum, the coccyx, and 
the right and left innominate or hip bones. These 
bones form a canal through which the child passes dur- 
ing labor. 

Measurements, or Diameters, are taken from certain 
parts of the pelvis to determine the capacity of this 
canal. It is important that every pregnant woman 
should have her pelvis measured by the physician whom 
she expects to have attend her in labor, in order that it 
may be discovered whether her pelvis is at all under 
size, so that special precautions may be taken in time to 
prevent difficulty in the delivery. These measurements 
should be taken not later than the seventh month of 
pregnancy, as it may be desirable, for the sake of both 
mother and child, that the physician should induce 
premature labor. 

The Canal of the Pelvis contains the internal organs 

17 



i8 



OBSTETRIC NURSING. 



of generation, viz., the uterus, Fallopian tubes, and ova- 
ries ; and the bladder and rectum besides. 

The External Organs are called the " pudenda," or 
"vulva." 

Immediately above the pubic bone, or anterior border 
of the pelvis, is a cushion of fat, usually covered with 
hair. This is called the " mons veneris." On each side of 
the opening of the vulva are the " labia majora," or 




Fjg. 



-Normal Pelvis. 



large lips. Lying beneath these and concealed by them, 
in young women, are two thin folds of flesh, named the 
" labia minora," or "nymphae." They join together 
above, and at their junction is a small projecting body 
called the " clitoris." The small triangular space between 
the clitoris and the nymphae is the " vestibule." 



THE PELVIS AND GENITAL ORGANS. 



19 



The opening of the urethra (the " meatus urinarius"), 
through which the urine escapes from the bladder, is in 
the middle of the lower border of the vestibule. It is 
very important that the nurse should know the exact 




Fig. 2. — External Genitalia. 

1. The right large lip. 2. The fourchette. 3. Right nympha. 4. Clitoris. 5. Urethral 
orifice. 6. Vestibule. 7. Orifice of vagina. 8. Hymen. io. Mons veneris. 11. 
Anal orifice. 

position of the meatus urinarius, as she will frequently 
be called upon to pass the catheter. 

Below the vestibule is the orifice of the " vagina," the 
canal leading to the uterus, or womb. In virgins a deli- 



20 OBSTETRIC NURSING. 

cate membrane, usually crescentic in shape, blocks the 
entrance to the vagina. This is the " hymen." 

The hymen is usually ruptured at marriage, but a 
woman may be a virgin, yet have no hymen ; in some 
cases it persists even after marriage and offers an ob- 
struction at childbirth. A woman who has borne chil- 
dren has a few fleshy projections at the orifice of the 
vagina, the only remains of the hymen, called the " car- 
unculae myrtiformes." Between the vulva and the anus 
is a mass of flesh, the space on the surface measuring 
one and one-half inches in length. During the birth of 
the child this becomes greatly distended, and thins like 
rubber. This is the " perineum." It may be torn during 
labor to a greater or less extent; sometimes it is com- 
pletely torn into the bowel. That part of the perineum 
in the virgin which forms the posterior border of the 
vulva is called the " fourchette." It is merely a fold of 
skin and is almost always torn in a first labor. Behind 
the perineum is the " anus " or orifice of the rectum, the 
lower part of the bowel. 

The Vagina is a canal connecting the external with 
the internal organs of generation. The uterus is at the 
top of the vagina. In front of the uterus is the bladder, 
and behind and to the left the rectum. 

A secretion of mucus keeps the vagina moist. There 
should, however, be no discharge in a perfectly healthy 
woman. During pregnancy, and as a result of ill- 
health or local inflammation, the natural secretion may 
be greatly increased, and the patient is then said to have 



THE PELVIS AND GENITAL ORGANS. 21 

" the whites." In labor the discharge is very greatly 
increased, so as to aid the birth of the child. 

The Uterus is a pear-shaped organ, three inches in 
length, one and one-half inches in breadth, and about one 
inch in thickness. It weighs a little over an ounce in 
its normal condition in a virgin. After child-bearing it 




Fig. 3. — Cavity of the Uterus and Fallopian Tubes. 

A. Superior border of fundus of womb. B. Cavity of the womb. C Cavity of the neck 
of the womb. D. Canal of the Fallopian tube. E. The fimbriated extremity. 
F. F. The ovaries. G. The cavity of the vagina. 

remains larger and heavier than before. That portion 
of the uterus which communicates with the vagina is 
called the "neck, or cervix." The chief portion of the 
organ above this is called the body, and the rounded 
upper surface the fundus. The opening in the cervix 
which communicates with the vagina is called the "os 
uteri." That portion of the cervix in front of the os 
uteri is the anterior lip, while that part which lies behind 
is the posterior lip. 

The Fallopian Tubes are two canals which pass 
from each side of the upper portion of the uterus. 



22 OBSTETRIC NURSING. 

They are from three to four and one-half inches long, 
and will admit the passage of a bristle. Each ends in 
a trumpet-shaped opening surrounded by a fringe of 
small projections called " fimbriae." This is called the 
fimbriated extremity. When the ovum (or egg) escapes 
from the ovary it is received by the Fallopian tube and 
reaches the cavity of the uterus in this way. 

The Ovaries are two small flattened bodies about an 
inch long and half an inch thick. They lie about an 
inch from the fundus of the uterus on each side, in the 
folds of the broad ligament. The broad ligaments are 
folds of peritoneum, a thin glistening membrane which 
covers the uterus and all the pelvic organs, and by 
means of which the uterus is suspended in the pelvis. 
The bladder and rectum being covered with the same 
tissue, there is an intimate connection between the 
three, so that if one is deranged the others are likely to 
be also. 

The Breasts are considered as belonging to the ex- 
ternal organs of generation. They are two glands situ- 
ated on the front of the chest, one on each side of the 
breast-bone. They vary in size and shape in different 
women, and during pregnancy they enlarge greatly. 
They secrete milk for the nourishment of the child. 
The nipple at the apex of the gland is a conical-shaped 
projection. The milk ducts all come toward it from the 
different parts of the breast and open on its surface. The 
areola is a pink or brown circle which surrounds the 
nipple. 



THE PELVIS AND GENITAL ORGANS. 23 

There is an intimate connection between the breasts 
and the uterus. Pain in the breast may be the result of 
disease of the uterus. The secretion of milk is called 
" lactation." 

Menstruation is a bloody discharge from the uterus 
every month. It begins usually about the age of four- 
teen and recurs every month, except during pregnancy, 
or while a woman is nursing. There are occasional ex- 
ceptions to this rule. It ceases at the change of life, or 
menopause (between forty-five and fifty). 

At puberty, that is, when this function first appears, 
the girl becomes a woman, the breasts enlarge, and the 
pelvis increases in size. The organs of generation be- 
come ready to perform the functions of reproduction. 
The menstrual flow recurs every twenty-eight days and 
lasts about four days. The quantity of blood lost at a 
period is from four to eight ounces. Different women 
vary much in this respect. The discharge is blood 
mixed with mucus. Its color is dark red. Any pecu- 
liarity in color, or the appearance of any clots in the dis- 
charge, will need to be noticed by the nurse and the 
discharge kept for the doctor's inspection. There is 
usually a feeling of discomfort at the menstrual period, 
with headache, pains in the back, breasts, etc. These 
symptoms are more severe in some women than in 
others. The periodic congestion of the uterus, which 
results in the production of the menstrual flow, is prob- 
ably associated with the ripening of the ova or eggs in 
the ovaries. It has been found, however, that the ova 



24 OBSTETRIC NURSING. 

may escape from the ovaries and be carried into the 
uterus through the Fallopian tubes independently of 
menstruation. The ova that do not become impregnated 
are simply carried away by the natural discharge. 

Conception most usually takes place immediately or 
very soon after a period. This is not an invariable rule, 
as women have become pregnant before menstruation 
has been established, or even after the menopause. 
They may also become pregnant while nursing. The 
principal disorders of menstruation are : — 

Dysmenorrhea, or painful menstruation ; 

Menorrhagia, or excessive flow at the period; 

Amenorrhea, or suppression of the menstrual flow ; 
and 

Metrorrhagia, the occurrence of hemorrhage between 
the menstrual periods. 

The causes of these disorders are very numerous and 
must be determined by a physician. 

A nurse is so often questioned on these points that it 
is well for her to have information concerning them. 
Always endeavoring to discourage the inquisitiveness of 
mere prurient curiosity, she should aim to give wise 
counsel concerning matters of which her patient may 
hesitate to speak to her physician. In doing so the 
nurse should, however, speak to the physician of any 
matters of importance concerning the condition of the 
patient which she may thus learn, and ask his counsel 
as to the advice she should give. 



CHAPTER II. 
SIGNS OF PREGNANCY. 

The Signs of Pregnancy may be divided into three 
classes : the suspicious, the probable, and the certain. 

Under the head of suspicious signs may be classed the 
many nervous sensations which are apt to accompany 
early pregnancy ; as, general discomfort, sudden changes 
of temperature, headache, toothache, giddiness, faint- 
ness, changes in disposition, perverted appetite, etc. 

Of the probable signs one of the earliest and most con- 
stant is the stoppage of the monthly flow in a person who 
has been regular. This may be, however, caused by 
other conditions than pregnancy. Thus, change in 
one's mode of living, a new climate, or general ill- 
health may produce the same result. In the early 
months of marriage we may also have an irregularity 
in menstruation where there is no pregnancy. On the 
other hand, in rare instances, we may have the monthly 
flow persisting for some months or throughout the 
entire pregnancy. It is then generally scanty and short 
in duration. 

A deepening in the color of the vagina and vulva, by 
which they take on a purplish hue, is another sign, and 

25 



26 OBSTETRIC NURSING. 

is caused by the enlargement of the blood-vessels and a 
stoppage of the circulation, due to pressure from the 
enlargement of the uterus. This coloration may be 
caused to some extent by tumors. 

Increase in the size of the breasts occurs in the early 
months of pregnancy with a deposit of coloring matter 
in the areola, or ring which surrounds the nipple. 
Some of this coloring matter seems to extend irregu- 
larly over the outer margin of the ring, and is called 
the " secondary areola" or "areola of Montgomery/' 
With this distention of the breasts there is also a secre- 
tion found in them — a watery fluid, sometimes yellowish 
in color, known as " colostrum," which appears about 
the third month. 

Temporary distention of the breasts, with the accumu- 
lation of this secretion, may occur in a slighter degree 
as an accompaniment of menstruation, or it may persist 
for a long time after a woman has stopped nursing her 
infant. 

Enlargement of the abdomen, which begins about the 
end of the third month of pregnancy, is another impor- 
tant sign. Yet this may also be caused by tumors, or 
by flatulence, or the deposit of fat in the abdominal 
walls. 

Marks upon the abdomen, due to the rapid stretching 
of the skin, sometimes occur in great numbers, and are 
called " strice" owing to the fact of their resemblance to 
the marks left by whip-lashes. These marks sometimes 
extend down upon the thighs. This, too, may be 



SIGNS OF PREGNANCY. 2J 

caused by tumors. The " brown line " of pregnancy is 
the deposit of pigment in the median line of the abdo- 
men. This may exist when there is no pregnancy, as 
also may the peculiar browning of the skin found in 
irregular patches over the face, particularly on the fore- 
head, and called the " mask of pregnancy." 

" Morning sickness" another sign, begins early in the 
second month or at the time of the first missed period. 
It is generally confined to the first three months and is 
largely a nervous symptom. It varies much, however, 
in degree and time of occurrence. Sometimes it is 
simply a slight feeling of sickness at the stomach occur- 
ring early in the morning; again, it may persist through- 
out the entire day, or it may occur one day and not 
again for several days. Sometimes it continues through- 
out the entire pregnancy, and is then dangerous because 
of the constant loss of food. Sometimes it occurs early 
in the pregnancy, then disappears to reappear in the 
last month, when there is direct pressure upon the 
stomach. 

" Quickening" — or the appreciation of the movements 
of the child by the mother — is another probable sign, 
and is first experienced about the middle of pregnancy. 
A woman who has previously borne children feels this 
sensation about two weeks earlier than one pregnant 
for the first time. 

There are other probable signs of pregnancy which 
would come only under the observation of the physician. 
As they require considerable knowledge of obstetrics 



28 OBSTETRIC NURSING. 

and skill in the conducting of an examination for the 
discovery of pregnancy, we will not do more than refer 
to them here. Hegars sign is the softening of the 
lower portion of the posterior wall of the uterus, and the 
increase of the antero-posterior diameter of that organ, 
as discovered by what is known as bi-manual palpation 
— one finger of the examiner resting over the posterior 
wall of the uterus through the rectum, while the other 
hand makes pressure over the lower part of the ab- 
domen. 

Another sign is that afforded by the thermometer, 
when its bulb is carried within the cervical canal. If 
pregnancy exist the temperature is said to be from a half 
to one degree higher than in the vagina. 

The pulse of a pregnant woman is said also to show 
less variation from change in position than that which 
occurs in the non-pregnant state. Thus the change 
from lying to sitting or standing does not cause a quick- 
ening, such as is usually observed in the non-pregnant 
state. 

The uterine souffle is a blowing sound which is sup- 
posed to occur in consequence of the enlargement of the 
blood-vessels of the uterus, and which, therefore, cor- 
responds in its rhythm with the radial pulse of the 
patient. This must not be confounded with the funic 
souffle, a blowing sound which sometimes occurs in the 
vessels of the cord and which is synchronous with the 
fetal pulse, therefore about twice as rapid as the mother's 
pulse. 



SIGNS OF PREGNANCY. 29 

When the uterus is large enough to be felt through 
the abdominal walls palpation over it is apt to cause a 
contraction, which is indicated by a temporary hardening. 
This is another indication of pregnancy. 

The positive signs of pregnancy as agreed upon by 
most obstetricians are but two : the direct appreciation 
of the parts of the child by touch, and the " fetal pulse," 
or heart sounds of the child. The " fetal pulse " is, as a 
rule, twice as fast as the pulse of the mother. It is 
hardly strong enough to be heard, even by experienced 
ears, much before the 5th month — or end of the 20th 
week — rarely heard well before the 24th week. 

Methods of Determining Date of Confinement. — 
The ordinary method of reckoning the probable date 
of confinement is as follows : Learn on what day the 
last monthly flow began, then count three months back- 
ward (or nine months forward) and add seven days. 
For example, say that a woman was unwell last on 
March 15, counting three months back gives December 
15 ; add seven days, and we have December 22 as the 
probable date of her confinement. All methods of 
reckoning are only approximate. It is best to consider 
the date calculated as the middle of a period of two 
weeks, within which labor may occur at any time. 
When, for any reason, it is impossible to make the cal- 
culation by this method, it may be computed by adding 
four and a half months to the date of quickening in the 
case of a woman pregnant for the first time, and five 



30 OBSTETRIC NURSING. 

months in the case of one who has previously borne 
children. 

The third method, that of adding forty weeks, or ten 
lunar months, to the date of conception, is too uncertain 
to be of much practical use. Examination of the patient 
by an intelligent physician who knows and appreciates 
the distinctive signs of the several months offers a 
fourth method of computing the date of pregnancy. 

Numerous tables for a rapid computation of the date 
of confinement have been made. The accompanying 
table is one much used. By taking the upper figure in 
each pair of horizontal lines as representing the date of 
the first day of the last menstrual period, the figure im- 
mediately beneath it will represent the probable date of 
confinement. 



SIGNS OF PREGNANCY. 



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CHAPTER III. 
MANAGEMENT OF PREGNANCY. 

The management of pregnancy consists, for the most 
part, in greater attention to the laws of health. The 
increased activity of all the organs of the body, together 
with the disturbances caused by pressure, necessitates 
this. 

Constipation is an almost invariable accompaniment 
of pregnancy. In the early months it is a sympathetic 
condition; later, the effect of direct pressure upon the 
bowels. It is also, undoubtedly, in part due to the want 
of exercise. 

The treatment of constipation is the same as in other 
conditions, except that only mild laxatives are used. 
Regularity in attention to the bowels, a glass of cold 
water at night and again in the morning, liquids (either 
milk or water), not taken with the meals, but in the in- 
tervals, a teaspoonful of common salt in the water occa- 
sionally, the use of uncooked fruit and coarse bread, the 
avoidance of starches and fine flour— all these are help- 
ful in overcoming this condition. There is an objection 
to the use of sugared fruits, as confections of fruit, 
senna leaves, etc., because of their liability to disturb 

32 



MANAGEMENT OF PREGNANGY. 



33 



the stomach. Prunes are, perhaps, the least objection- 
able ; licorice powder, because of the senna which it 
contains, is apt to cause griping pains. Rhubarb is, 
perhaps, the best of the mild laxatives. A small piece 
of rhubarb root, the size of a pea, may be taken at 
night, followed by a glass of water. If there is an objec- 
tion to its taste, it may be taken in pill form. Cascara 
sagrada is also useful. 

Cream of tartar, a half a teaspoonful being taken at 
night in a cup of cold water, is often efficient. In some 
cases it may be necessary to repeat the dose in the 



morning. 



Massage of the abdomen, so efficient in the manage- 
ment of constipation, should never be resorted to in the 
pregnant state, as it is apt to excite uterine contractions 
and may lead to miscarriage. There is an objection to 
the too frequent use of enemata on the same ground ; 
also, the habit is thus acquired of depending upon this 
stimulus, and overdistention of the bowel is the result. 
It may be necessary, however, occasionally to alternate 
an enema with a laxative, especially when the patient 
suffers from piles. 

Diarrhea is rather a rare disturbance of pregnancy, 
but it sometimes occurs as a direct result of constipa- 
tion- — small, hardened masses forming in the bowel, 
known as " scybala," which produce an irritation of the 
mucous lining. The use of rhubarb night and morning, 
in the manner described above, until all the masses are 
removed from the bowels, will serve to check the 
3 



34 OBSTETRIC NURSING. 

diarrhea. Should the condition be due to other causes, 
as indigestion, etc., appropriate remedies will have to be 
prescribed by a physician. 

Changes in the Urinary Organs are mainly due to 
direct pressure. In the first three months of pregnancy 
there is direct pressure on the bladder, hence great irri- 
tation, due to interference with the distention of the 
bladder, producing a constant desire to pass water. For 
this the recumbent position is the only help. The 
uterus rises in the abdomen at the end of the third 
month, and the bladder being thus relieved from pres- 
sure, this symptom passes away. 

The tendency from the fourth to the ninth month is to 
the accumulation of urine, because there is less than the 
proper irritability of the bladder, the organ being flat- 
tened between the uterus and the abdominal walls, and 
its walls thereby suffering a partial paralysis. 

In the last month there is incontinence of urine, be- 
cause the pressure is so great that there is no room for 
the accumulation of urine. 

During labor there is pressure upon the neck of the 
bladder and urethra, leading to retention. This may 
exist for the last two weeks of pregnancy. Necessity 
for the use of the catheter is confined, as a rule, to this 
period. The distention of the bladder may impede 
labor. With the drawing up of the uterus the bladder 
is drawn up and the urethra elongated, hence the use of 
the long rubber catheter, known as the English cathe- 
ter, will be necessary. Nos. 8 and 9 are those ordinarily 
used. 



MANAGEMENT OF PREGNANCY. 



35 




Sometimes irritability of the bladder is due to exces- 
sive acidity of the urine. A physician will generally 
prescribe some alkali to overcome this condition, as a 
drop of liquor potassa in a tablespoonful of milk once 
in three or four hours, or the 
use of mucilaginous drinks, as 
flaxseed tea, barley water, milk, 
etc., may relieve the distress. 

When the abdominal walls 
are much stretched and the 
uterus falls upon the bladder, 

- Fig. 4.— Abdominal Belt. 

this may be remedied by the 

use of the binder or an abdominal supporter. 

Incontinence of Urine leads to the excoriation and 
reddening of the parts about the vulva. Frequent 
washing with warm water and borax or pure castile 
soap relieves the irritation. Diachylon or zinc ointment 
is best when an ointment is needed. 

Incontinence is sometimes the result of over disten- 
tion of the bladder. Here the use of the catheter is 
indicated. 

A nurse, unless thoroughly experienced, should never 
attempt passing the catheter in the case of a pregnant 
woman, as serious injury may be done to the soft parts 
in a bungling attempt. In all cases she should have the 
sanction of the physician before so doing. 

The Kidneys are especially subjected to pressure 
from the seventh to the ninth month of pregnancy. A 
passive congestion is thus produced, which may lead to 



36 OBSTETRIC NURSING. 

the occurrence of albuminuria, or albumin in the urine. 
This is an evidence of a drain upon the blood which 
the physician needs to watch very carefully. It is cus- 
tomary, therefore, for physicians to examine the urine 
of patients whom they expect to attend, at least once a 
week, from the seventh month on to the termination of 
pregnancy. A specimen obtained by the use of the 
catheter is the best for the purpose, if the patient be 
troubled by a discharge from the vagina. 

There is a natural increase in the amount of urine 
passed by a pregnant woman, but the increase is mainly 
in the water. Therefore the urine will be lighter col- 
ored than usual. The reaction of the urine should be 
acid. 

Should the reaction be alkaline, or the quantity of 
urine diminished rather than increased in amount, the 
fact should be reported to the patient's physician. 

Leucorrhea, a discharge from the vagina, commonly 
known as " the whites," is much increased often during 
pregnancy, and is due to the greater activity in the secre- 
tion of all the mucous membranes. If a vaginal dis- 
charge be of a white, yellow, or green color, it indicates 
inflammation of the vagina itself. The discharge, on 
reaching the vulva and coming in contact with the air, 
decomposes and becomes irritating. Cleanliness is im- 
portant in overcoming the effects of this. The itching 
induced by it is sometimes very obstinate, and generally 
worse at night. A solution of borax and water for 
bathing the parts, or carbolic acid, 15 to 20^ to a pint 



MANAGEMENT OF PREGNANCY. 37 

of water, will often give relief. Should vaginal injections 
be ordered by the physician, they should be given with 
great caution. A fountain syringe should be used, 
which produces a continuous stream. The interrupted 
stream should never be employed. In some conditions of 
excessive discharge the physician may prescribe tannic 
acid suppositories to be used nightly in the vagina. 
After a thorough drying of the parts surrounding the 
vulva, they may be dusted with a powder consisting of 
one part powdered camphor to four parts starch. This 
often gives great relief. Calomel powder may be used 
in the same way. 

Hemorrhoids, or Piles, are often very troublesome 
during the latter part of pregnancy. Lying down im- 
mediately after a movement of the bowels, and remain- 
ing in the recumbent position for ten to fifteen minutes, 
will tend to relieve them, also care in obtaining a daily 
evacuation of the bowels, and the use of means to secure 
as soft a movement as possible. Should the piles come 
down they should be fomented by cloths wrung out in 
hot water, to which a little Pond's Extract or fluid ex- 
tract of hamamelis may be added — one tablespoonful, or 
two, to one pint of water — and when shrunken, anointed 
with cold cream or cosmoline and returned into the 
bowel. 

Sometimes the case is so aggravated as to necessitate 
keeping the patient in bed for a time. A physician 
should, of course, be consulted about the treatment. 

Swelling and Pain of the external organs of gene- 



38 OBSTETRIC NURSING. 

ration and of the lower limbs, resulting from pressure 
and the over-distention of the blood-vessels, is best re- 
lieved by the recumbent posture. 



Fig. 5. — Spiral Reverse Bandage of Lower Extremity. 

Should the veins of the legs be much enlarged, or the 
feet swollen, the patient should have compression made 



MANAGEMENT OF PREGNANCY. 39 

over them by the application of a bandage (the spiral- 
reverse of the lower limb), or she should wear an elastic 
stocking, such as may be obtained of any good instru- 
ment maker. For the bandage the best material is 
flannel cut bias, the width being about three inches. 
The bias bandage makes more even compression. Great 
harm may result from the neglect of enlarged veins, as 
they sometimes become so distended as to burst. Prof. 
T. S. K. Morton has devised a method of putting on a 
spiral bandage of the lower extremity, which retains its 
place better than that just described, which is apt to 
loosen when the patient moves about. Dr. Morton 
begins the application of his bandage as in the ordinary 
spiral reverse bandage of the lower limb, but carries 
oblique turns up and down the limb until its surface is 
entirely covered, in place of making reverses. When 
this bandage is further secured in place by carrying a 
running line of stitches up both the inner and outer side 
of the limb, it keeps its place perfectly and is quite as 
serviceable as an elastic stocking. 

Pain caused by the stretching of the walls of the 
abdomen may be relieved by thorough inunction of the 
skin. Cotton-seed, olive, or cocoanut oil may be used 
for the purpose. 

Severe pains in the back, neuralgic in character and 
so severe sometimes as to prevent the patient from 
sleeping, may yield to change of position, relieving 
pressure. Rubbing with soap liniment, volatile liniment, 
whisky, or any liniment not too active, is helpful. 



4-0 OBSTETRIC NURSING. 

Warm hip-baths may sometimes be prescribed by a 
physician. 

The Salivary Glands are in some cases very active 
during pregnancy, inducing so excessive a secretion of 
saliva as to cause the patient great annoyance. This 
trouble is generally very intractable, and may refuse to 
yield to all treatment, ceasing only with parturition. 
Astringent washes, as of tannic acid, alum, myrrh, etc., 
may be tried, as also the use of pieces of ice. Physi- 
cians sometimes use atropia in small doses. Its use 
requires careful watching. 

Bad Teeth, which occur so often during pregnancy, 
are said to be due to acidity of the saliva. A little 
baking soda or prepared chalk placed in the mouth at 
night will counteract the effect of this acidity when it 
exists. The question is often asked whether there is 
any danger in having the teeth filled or attended to dur- 
ing pregnancy. There is always some danger, because 
a certain amount of nerve-irritation is the result. If 
the patient be suffering, however, it is better to have 
them filled by a temporary rubber filling, which causes 
little pain or irritation, than to lose rest in consequence, 
of toothache. Extraction of the teeth should only be 
allowed when absolutely essential. If the pain be sim- 
ply a neuralgic pain, it is better to wait. 

Vomiting is, as has been said in the preceding chap- 
ter, a most common accompaniment of pregnancy. It 
more frequently exists, perhaps, with the first pregnancy 
than any other. The act is accomplished, as a rule, 



MANAGEMENT OF PREGNANCY. 4 1 

without much effort. Diet seems to have little effect 
upon it. Various articles have been recommended for 
it, as rice-water, beef-tea, barley-water, the various 
gruels, the yolk of a hard-boiled egg, scraped beef in 
the form of sandwiches, ice-cream, cracked ice, etc. In 
some cases one or another of these seems to relieve the 
irritation. A cup of coffee, weak tea, or milk, taken 
warm early in the morning before the patient raises her 
head from the pillow, will often act as a preventive. 
In extreme cases of vomiting rectal' feeding must be re- 
sorted to. In obstinate vomiting it is important that 
the physician should examine for the position of the 
uterus or the existence of ulcerations or erosions. 

It must not be forgotten that the constant loss of 
food may be so great a drain upon the patient's strength 
as to endanger her life. As this symptom is so largely 
sympathetic, the proper use of bromides or other nerve 
sedatives prescribed by a physician may be of great use 
in checking it. 

Care of the Breasts in a pregnant woman necessi- 
tates careful attention to the prevention of compression. 
Full development should be permitted by the looseness 
of the clothing. The importance of the proper dress- 
ing of growing girls cannot be overestimated in this 
connection. Did mothers realize the evils — of which 
the atrophy of the breasts is but one — resulting from 
tight lacing, there would be fewer unhealthy women 
and fewer mothers unable to nurse their offspring. The 
nipples should be prevented from rubbing, and the skin 



42 OBSTETRIC NURSING. 

over the nipples should be strengthened by using the 
nipple-bath — filling a small, wide-mouthed bottle one- 
third full of cold water and inverting it over the nipples 
daily, from five to ten minutes at a time. Sometimes a 
little cologne-water or alcohol is added to the nipple- 
bath, or, better still, borax in the proportion of one 
tablespoonful to the pint of water. Keeping off scabs 
and concretions of various kinds from the surface of 

the nipples by the use of a little oil 

jaiig, is also admissible. This keeps the 

^^^^^^^^ skin pliable. The use of the nipple- 

^t _Jj»^ protector, which will be referred to 

F I l 6 .-Nipple Protector. m ° re full y in the chapter OU the 

management of the lying-in, is of 
great importance where there is a tendency to flattening 
of the nipple, to remove the pressure of the clothing. 
Drawing out the nipple gently between the thumb and 
finger is also helpful in overcoming this tendency. 

The Clothing of a pregnant woman should be worn 
loose from the very beginning, both because the breasts 
begin to enlarge early and corsets interfere with their 
development, and because any amount of pressure upon, 
the intestines tends to produce uterine displacements, 
which are especially dangerous during pregnancy, as 
they predispose to abortion. The clothing should all 
be supported from the shoulders. 

Many new dress reform systems are now in vogue, 
having for their object the great desideratum of adjust- 
ing woman's dress so as to make it both healthful and 



MANAGEMENT OF PREGNANCY. 



43 



beautiful. Fortunately, in this enlightened age ideas of 
physical culture are so modifying old-time ideas of 
beauty that the wasp waist, the multitudinous and vol- 
uminous skirts, the awkward and deforming bustle, the 

high-heeled boot, are fast becom- 
ing relics of the past. Among 
the dress-reform systems now in 
existence there is none so fully 
meets my views of healthful and 





Fig. 7. — Jenness-Miller 
Chemilette. 



Fig. 8. — Jenness-Miller Divided Skirt. 



beautiful dressing as the Jenness-Miller System. But 
few garments constitute the costume, and these are so 
constructed as to allow perfect freedom of every part of 
the body. 

A complete costume for summer wear, according to 



44 



OBSTETRIC NURSING. 



this system, would consist in the chemilette — a com- 
bined chemise and a pair of drawers — around the waist 
of which buttons may be fastened, to which the second 
article of dress, the divided skirt, or Turkish leglette, is 
buttoned. The latter is made so full that it takes the 
place of petticoats, and the dress may be comfortably 





Fig. 9. — Union Undergarment. 



Fig. 10. — Jenness-Miller Leglette. 



worn over it. Should the dress be of some very sheer 
material, one additional muslin petticoat may be worn, 
similarly fastened to the waist of the chemilette. If a 
person is accustomed to wearing merino or silk under- 
wear both summer and winter, the jersey-fitting union 
under-garment may be worn beneath the chemilette, or, 



MANAGEMENT OF PREGNANCY. 45 

the latter being dispensed with, the Jenness-Miller 
" model bodice/' or the Equipoise waist and divided 
skirt, may be worn alone over the union under- 
garment* 

For winter wear, plain leglettes of flannel, cashmere, 
or silk, or the same material as the dress, may be worn 
over the union under-garment and directly beneath the 
dress. Thus underskirts are entirely dispensed with 
and all the clothing is supported from the shoulders. 

The skirts of winter dresses, being comparatively 
heavy, should be fastened to a waist of their own which 
has comfortably-cut armholes. 

Garters fastened to the waist are discountenanced, ac- 
cording to this system — as they should be, for they pro- 
duce too much dragging on the waist, and the spiral- 
spring Duplex Ventilated garter is recommended to be 
worn until something better is devised. 

It is probable that the fashion will come into vogue of 
combining the stockings with the union under-garment, 
when garters will be done away with entirely. 

It is well for the stockings to be of wool or silk. 

The shoes or slippers worn should be comfortable and 
with broad soles and low heels. 

Slender women can well wear the chemilettes, dis- 
pensing with all boned waists. Stout women, having 
busts, find more comfortable the model bodice, or the 

* The Delsarte waist, more recently devised, has a similar object in meet- 
ing the hygienic and artistic requirements of woman's dress. 



4 6 



OBSTETRIC NURSING. 




Fig. ii. — The Equipoise Waist. 



Equipoise waist,* which, I believe, is not one of the gar- 
ments of this system, but an exceedingly comfortable 

one, in my opinion. The Del- 
sarte breast support recently de- 
vised is a form of breast support 
which aims to support the weight 
of the breasts from the shoulders, 
so that waists containing bones 
may not be regarded as a neces- 
sity, even by the stout. Both 
the ''model bodice" and Equi- 
poise waist (the latter of which 
I prefer) contain bones, but dis- 
pense with the front steels, so injurious in the ordinary 
corset. 

For the changes in shape induced by advanced preg- 
nancy the union under-garments will need to be of 
larger size than those ordinarily worn (about two sizes 
larger). Many beautiful designs for dresses and other 
outer-garments have been devised by Mrs. Miller, pat- 
terns for which may be obtained of the Jenness-Miller 
Co., in New York, or its agencies in other cities. Before 
leaving the subject I would mention, as one especially 
praiseworthy feature of this system, the perfect use of 
the arms permitted by the ingeniously devised patterns 



* This, with the other garments mentioned, may be obtained through 
the Dress Reform Emporiums in Philadelphia, or similar agencies in other 
cities. 



MANAGEMENT OF PREGNANCY. 47 

for sleeves and shoulder straps. If the skirts are not 
fastened to a properly constructed waist as described, 
they should be supported by suspenders. 

When the abdominal walls are much relaxed from 
stretching, allowing the womb to fall forward, it is well 
to use an abdominal binder or belt, especially during the 
last month of pregnancy. This helps to keep the uterus 
in proper position. 

Flannel should be worn — at least during pregnancy — 
both summer and winter. A lighter flannel can be sub- 
stituted in summer for that which would be worn in 
winter. The use of flannel is to prevent chilling of the 
surface, and this is especially important where — as in 
pregnancy — the kidneys are overworked. It is im- 
portant also for the condition of the heart and lungs. 
Coughs often cause premature labors. The jersey-fitting 
knit union undergarment, before referred to, maybe 
obtained in all grades and sizes and is well suited to the 
purpose. 

Bathing is very necessary for a patient during her 
pregnancy, as at other times. As regards the character 
of the bath, she can do as she has been accustomed to, 
using warm or cold water. A change from warm to 
cold water, or vice versa, is, however, not allowable. A 
sponge-bath, followed by brisk rubbing, is the most 
desirable: The skin is thus kept in good condition. 
Shower-baths should be avoided. 

Sea Voyages are injurious, because of the danger of 
receiving falls or blows in consequence of the motion of 



48 OBSTETRIC NURSING. 

the vessel, and also because of the liability to sea- 
sickness induced by them. When it is absolutely neces- 
sary to take a sea voyage, there is probably least danger 
in the last three months of pregnancy, because the pla- 
centa, or afterbirth, is then well developed and its 
attachment to the uterus close. 

The Regulation of the Diet during pregnancy is of 
great importance. A patient should eat heartily for 
breakfast and dinner, but the evening meal should be 
light, especially from the seventh month on to the close 
of pregnancy. This meal should consist of stale bread, 
with butter and cooked fruit, as stewed apples, and a 
glass of milk or weak tea. Digestion is less active in 
the latter part of the day, and often a hearty meal may 
prove the direct exciting cause of convulsions. The 
food should be plain, wholesome, nourishing, well- 
cooked, and chosen in each case with special reference 
to the avoidance of digestive disturbances and constipa- 
tion. Meat in moderate quantity, broths, milk, eggs, 
and fresh fruit should constitute an important part of 
the dietary. Pastry and confections should be avoided. 

There is a mistaken theory prevalent in this day that 
a mother, by abstaining from certain kinds of food, as 
meat, eggs, milk, etc., and confining herself chiefly to a 
fruit diet, may thus, by preventing the hardening of the 
bones of the child, do away largely with the pains of 
labor. The truth of the matter is this : that during 
pregnancy all the functions of the mother's body are 
especially active in promoting the development of the 



MANAGEMENT OF PREGNANCY. 49 

child, hence an insufficient supply of essentially nourish- 
ing food will first affect the mother's system and render 
her unfit for the demands upon her strength at the time 
of parturition. 

Should a restriction to the fruit diet effect what it is 
claimed to do as regards the infant, it would result in the 
production of sickly, rachitic children, poorly developed 
mentally and physically. 

Moderate Exercise is essential during pregnancy. 
Walking on a level, not riding, is the best form of exer- 
cise. A daily walk should be taken, not, however, after 
nightfall. The patient should avoid lifting — in fact, all 
straining movements — and most particularly should she 
avoid the use of the sewing-machine. Exercise, judi- 
ciously taken by the pregnant woman, serves to prevent 
undue development in the size of the child, and in this 
way serves to make her labor easier. 

Maternal Emotions. — There is sufficient proof that 
the mother's emotions influence the child to render it 
important that her surroundings during pregnancy 
should be as pleasant as possible, and that she should 
avoid fright or any violent emotion. At the same time 
there is no ground for the popular belief that when a 
pregnant woman is thus frightened her child will be 
" marked." 

Complications of Pregnancy. — Chorea, or St. Vitus' 
Dance, Epilepsy, and Insanity are forms of nervous dis- 
orders which sometimes complicate pregnancy. Such 
cases require skilled medical treatment. 
4 



50 OBSTETRIC NURSING. 

Patients with heart trouble, and those who are con- 
sumptive, also require constant medical supervision, as 
pregnancy has a deleterious influence upon them. Con- 
sumptives sometimes feel better while pregnant, but sink 
rapidly afterward. 

Those diseases which are associated with high tempe- 
rature, such as the eruptive fevers and inflammation of 
the lungs, have a marked tendency to bring on the labor 
before time. There is also danger of their inducing 
puerperal septicemia. 

Syphilis is a constitutional disease and a form of 
blood-poisoning which also has an injurious effect upon 
pregnancy. If the pregnancy does not terminate 
prematurely the child is usually born with the taint of 
the disease. 



CHAPTER IV. 
ACCIDENTS OF PREGNANCY. 

A Discharge of Blood from the womb, known as 
" uterine hemorrhage," may occur at any time during the 
pregnancy, and is usually a sign that the patient is threat- 
ened with a miscarriage. However slight the flow, the 
nurse should have the patient lie down until the doctor 
has been told of its occurrence, and decides what the* 
patient should do. A note should be sent to the doctor, 
telling just what has happened, and clearly making him 
understand the urgency of the symptoms — that is, the 
amount and character of the flow — and the condition of 
the patient. A nurse should not trust to a verbal mes- 
sage, as the physician may fail to respond to the call 
promptly, not being aware of the urgency of the symp- 
toms. The patient should be required to use the bed- 
pan, or, at least, a vessel the contents of which can be 
thoroughly examined, both for the bowels and the pas- 
sage of urine. All discharges, soiled clothing, clots, 
etc., should be carefully saved for the inspection of the 
physician. 

Meantime, an effort should be made on the part of the 
nurse to control the flow. The patient should lie with 

Si 



52 OBSTETRIC NURSING. 

her head low, and a pillow under her hips; she should 
not be warmly covered, plenty of cool, fresh air should 
be admitted into the room, and she should be kept ex- 
ceedingly quiet. 

Should the symptoms become more urgent, the patient 
being threatened with fainting, the head may be lowered 
by raising the foot of the bed, placing bricks or chairs 
under it in such a way as to make a decided inclined 
plane of the bed. The patient should be fanned, given 
hartshorne to inhale, and her limbs rubbed, to keep 
them warm, with alcohol or whisky. Small doses of 
whisky or aromatic spirits of ammonia may be given 
her. in cold water, if able to swallow, or black coffee or 
tea, not too warm. If there is much blood flowing from 
the vulva, vaginal injections of hot water, at a tempera- 
ture of about uo° to 1 1 5°, may be kept up until the 
flow ceases. The physician when called may think 
it best to tamponade the vagina. For this purpose long 
strips of sterilized gauze or sheeting may be needed, 
which the nurse should have in readiness. 

Alarming hemorrhages are often the result of acci- 
dents, falls, or blows, or they may be caused by heavy 
lifting. 

Hemorrhage from a Low Attachment of the Pla- 
centa, or afterbirth, or when the afterbirth occupies an 
unusual position — that is, at the side of or over the 
mouth of the womb — occurs without any history of 
accident. It takes place at any time from the seventh 
month of pregnancy on to its termination, and without 



ACCIDENTS OF PREGNANCY. 53 

any premonitions of its coming. It may occur at night 
while a patient is lying in bed. The management of this 
condition would be the same as that described above, 
until the doctor comes. 

Hemorrhage from Varicose Veins. — Women suf- 
fering from enlarged, swollen veins, " varicose veins," or 
" varices," of the lower extremities, if not careful in 
keeping the limbs bandaged or supported by elastic 
stockings, may have hemorrhage occur by the bursting 
of one of these over-distended veins. The amount of 
blood lost may be so great as to imperil the patient's 
life. Should such a rupture of a vessel occur, compres- 
sion should be made just below the point of rupture, to 
control the bleeding, until the physician, who should 
have been sent for, arrives, when he will resort to the 
measures necessary for securing against further hemor- 
rhage. 

Miscarriages are apt to recur, hence a patient who has 
once suffered from one should be cautioned to take addi- 
tional care of herself during any subsequent pregnancy. 
Any sensation of weight about the hips, with the recur- 
rence of a "show," or slight discharge of blood, and 
cramp-like pains should warn her to lie down and send for 
her physician. Such a patient should also take the precau- 
tion to lie down as much as possible (if not in bed, on a 
lounge) during the time when, under other circumstances, 
she would have her monthly flow. Any patient having 
had a number of miscarriages should keep herself under 
the care of her physician from a very early date in the 



54 OBSTETRIC NURSING. 

pregnancy, being placed under a regular course of treat- 
ment. 

It is well, in this connection, to speak of the import- 
ance of care in the after-treatment of miscarriages. Not 
uncommonly, patients, especially of the working classes, 
get up and' go about their work a day or two after the 
occurrence. This is a dangerous proceeding, for, though 
the ill effects may not be felt for a time, chronic disease 
of the uterus is apt to result. If the pregnancy termi- 
nates before the fourth mouth it is commonly called an 
abortion. Between the fourth and seventh month it is a 
miscarriage, and after the seventh month, if before term, 
a premature labor. 

It is really necessary to give more time to the recov- 
ery from the effects of an abortion, than to recovery from 
a confinement at term, and the patient should be willing 
to remain in bed at least a week or ten days, or longer, 
if thought best by her physician. The patient should 
not leave her bed so long as any discharge of blood 
continues. 

Premature Rupture of the Membranes enclosing 
the child, with a discharge of colorless liquid, commonly 
known as " breaking of the waters," is another of the 
accidents of pregnancy, and is invariably followed, within 
a few days, at least, by the expulsion of the child. The 
patient will complain of her clothing becoming wet, 
either by a sudden discharge of a quantity of liquid, or 
by a slow but continuous flow. The nurse can assure 
herself that this liquid is not urine by her sense of smell. 



ACCIDENTS OF PREGNANCY. 55 

The smell of urine is characteristic. With the amniotic 
liquid surrounding the child, there is almost an entire 
absence of smell, a peculiar, faint, musty odor being 
alone recognizable. 

It is best, in removing this wet clothing from the pa- 
tient, to set it away, that the physician may judge for 
himself of the character of the liquid. The patient 
should at once lie down, not taking the erect position 
for any cause, not even for defecation and urination, and 
the physician should be sent for, with a written state- 
ment as to what has occurred. It is important that the 
physician should see the patient as soon after the rupture 
of the membranes as possible, because the sudden loss 
of water may have brought about changes in the position 
of the child, which may endanger its life. The loss of 
the entire amount of liquid contained in the sac would 
cause also difficulties in the delivery, or what is known 
as " a dry labor." 

Convulsions may sometimes occur during the preg- 
nancy. The symptoms which threaten this trouble are 
extreme restlessness and uneasiness on the part of the 
patient ; severe headache, often confined to one side of 
the head ; disorders of vision, as seeing things double, or 
seeing but the part of an object, sometimes very imper- 
fect vision, and occasionally absolute loss of sight ; 
twitchings of the muscles, especially of the face, may 
occur. The convulsion is ushered in by this restlessness 
and twitchings, beginning first about the eyes and ex- 
tending rapidly to the mouth, arms, and lower extremi- 



56 OBSTETRIC NURSING. 

ties. The movements are not violent, hence the patient 
is not likely to throw herself out of bed. The physician 
should be sent for ; meantime, the nurse should see that 
the patient is kept lying down, that her clothing is well 
loosened, especially about the head and chest, that plenty 
of fresh air enters the room, and that the patient is kept 
from biting her tongue. A folded handkerchief or towel 
slipped in between the teeth pushes back the tongue and 
prevents the teeth from coming down upon it. When 
the physician comes he will probably use an anesthetic 
to relax the spasm, until the system can be gotten under 
the effect of such nerve sedatives as he may direct to be 
administered from time to time. 

The patient's feet should be kept warm and head cool. 
The members of the family must be kept calm and pre- 
vented from meddlesome interference, for the attempt to 
make the patient swallow any stimulant while struggling 
and unconscious may result very disastrously. Should 
the attending physician live too far away or be delayed 
in coming, the nearest physician should be sent for. 



CHAPTER V. 
GERMS AND ANTISEPSIS. 

One of the most important things for an obstetric 
nurse to know is the meaning of the term "antisepsis" 
and the method by which antisepsis may be carried out 
in her work. 

Literally, the term " antisepsis" means " against sepsis 
or putrefaction " and refers to the application of means 
by which objects may be rendered entirely free of all 
poisonous elements. 

Dust, as we know, is everywhere present in the atmos- 
phere, and consequently settles upon everything exposed 
to it. This dust consists, as has been found, of very 
minute organisms, which, when they are planted in a 
suitable soil, grow and multiply very rapidly, producing, 
as a result of their activity, the poisonous fluids and 
gases which characterize the process of putrefaction. 

These products are called ptomains. The substances 
thus formed, when absorbed into the blood, give rise to 
the symptoms of blood-poisoning. It may, therefore, 
be plainly seen that the simple neglect of measures to 
destroy these dust germs may, by allowing decomposi- 
tion of the natural discharges, lead to septic poisoning. 

57 



58 OBSTETRIC NURSING. 

It has been found, as a matter of experience, that 
other diseases besides those commonly classed under 
the head of " childbed fever," or " puerperal sepsis," 
may be induced by these small germs, and this explains 
why it is so very important that erysipelas, scarlet fever, 
or other acute contagious diseases should be avoided by 
those engaged in obstetric practice. A nurse leaving 
such a case to go to a confinement case will do so at the 
risk of her patient's life, for puerperal fever will almost 
certainly be induced by the germs which she carries 
from the former case. 

Germs. — The minute bodies known as germs are, we 
see, greatly to be dreaded. They are of three kinds : 
first, those to whose action most of the infective diseases 
are attributed, and which are divided, according to their 
shape, into micrococci, round-shaped bodies ; bacteria, 
oval-shaped bodies ; bacilli, rod-shaped bodies of varying 
length ; and spirillse, or spiral, thread-like bodies ; sec- 
ond, yeasts ; third, molds. 

To give an idea of their size, it has been said of one 
of the most common forms of germs (the rod-like), were 
fifteen hundred of them put end to end they would 
scarcely reach across the head of an ordinary pin. 

Their rate of growth, too, is very rapid, a common es- 
timate being that they double themselves once or twice 
every hour. Thus, in the course of twenty-four hours a 
solitary germ may become a colony of between sixteen 
and seventeen millions. 

Warmth, moisture, and a certain amount of organic 



GERMS AND ANTISEPSIS. 59 

matter are the conditions which favor their development. 
Most, but by no means all, forms of bacteria require air ; 
some, however, can only develop in the absence of air. 

Germs may grow by division ; that is, one of them 
may have a constriction form about its middle which 
finally becomes a complete partition, so that two distinct 
germs are thus formed. These similarly divide, and 
thus their number multiplies. Another method of 
growth is by spore formation. At one or more points in 
a rod an oval spot appears, which becomes brighter and 
clearer. These spots are spores, and when fully devel- 
oped they become free, the rest of the rod dissolving 
away. These spores retain their vitality for years, ready 
at any moment when suitable conditions are provided to 
develop into fully formed germs. It is extremely diffi- 
cult to destroy the vitality of these spores. Many anti- 
septics which readily kill the adult germs will not harm 
the spores — or only do so after a much longer time than 
that necessary for the adult germ. 

Even where the antiseptics do not kill, however, they 
may retard the development of these germs and thus 
prevent their doing injury. 

In all germ diseases a battle is fought between the 
patient's body and the germs with which it is infected. 
If the germs are present in small quantity only, it is 
possible the resisting power of the body may enable 
them to be overcome. 

If, however, the general health is impaired by over- 
work, deficient food, overcrowding, or other depressing 



60 OBSTETRIC NURSING. 

influences, the patient will be more likely to succumb to 
the attack. This explains why some patients escape 
under the same conditions in which others suffer from 
blood-poisoning. 

Lying-in patients are especially liable to germ infec- 
tion, both because the labor leaves them in a state of 
exhaustion, and because there are always certain open 
surfaces present upon or within such a patient's body — 
so that these serve as direct avenues for the entrance of 
poison into the system. The site within the uterus from 
which the placenta or after-birth is detached is one of 
these ; others being the fissures or lacerations about the 
neck of the uterus, the vagina, or perineum. This shows 
the importance of protecting from decomposing dis- 
charges all such open surfaces. 

Experiment has shown that bruised tissues are especi- 
ally liable to destructive inflammation from the action 
of germs. This explains why first labors and difficult 
and tedious labors are most apt to be followed by septic 
infection. 

Should such a labor be followed by the occurrence 
of sloughing wounds, it is therefore especially important 
that any discharges from the wound should not be 
retained, but kept carefully removed by means of anti- 
septic irrigation, etc. Care should be taken that the 
antiseptics used should not be in sufficient strength, how- 
ever, to irritate the wound, as this may increase the 
trouble. 

Any condition, such as an attack of inflammation, 



GERMS AND ANTISEPSIS. 6 1 

exposure to cold, or disordered digestion, because it 
lowers the vitality of the body, tends to increase the 
tendency to septic infection. 

Besides the diseases resulting from the classes of 
germs most commonly concerned in the production of 
putrefactive changes in the body, we have some which 
are due to " mold-infection " and the action of yeasts — 
which are also lowly organisms existing in great num- 
bers in the atmosphere, and capable of setting up 
destructive changes in tissues. It is the " molds " 
which are the cause of food spoiling when allowed to 
stand exposed to the air. The disease known as 
" thrush, " which is characterized by grayish patches 
forming upon the mucous membrane of the mouth and 
adjacent parts, is due to a parasite which is one of the 
" yeasts." A number of skin diseases are caused by the 
growth of " molds." 

Experiments. — In order to prove the fact that animal 
fluids will not undergo putrefaction if germs are excluded 
from them, a series of very interesting experiments were 
made for a class in one of the London hospitals recently, 
to illustrate some of the most common errors in nursing. 
These can be repeated for class instruction anywhere. 

A series of glass tubes were taken, into which some 
sterilized beef-tea or beef-jelly was introduced. Into 
two of these tubes scrapings from under the finger-nails 
were placed, and in one the little specks were soon seen 
to eat their way into the jelly, followed by a trail of 



62 OBSTETRIC NURSING. 

microbes. In the other tube a dense mass of molds 
developed, and the beef-jelly was transformed into a 
dark brown color. 

Into a third tube a piece of cotton used in wiping the 
vulva of a lying-in woman, previous to passing the 
catheter, was dropped, with the result of showing almost 
immediately a mass of germs which descended into the 
jelly, liquefying it by their presence, while the cotton, 
owing to the air it contained, floated on the surface. 

A drop or two of urine from the bladder of a patient 
suffering from inflammation which had resulted from the 
use of an impure catheter, was introduced into a fourth 
tube containing the sterilized beef-jelly. This caused 
the jelly from above downward to be converted into a 
dirty- looking yellow fluid, while a whitish mass of germs 
accumulated on the surface of the jelly. 

The importance of antiseptic precautions in the nurs- 
ing of infants was well illustrated by two other experi- 
ments. Into a tube containing some of the sterilized 
beef-jelly a drop of sour milk was placed ; very rapidly a 
moldy coating appeared over the surface of the jelly. 
When we think of a similar process taking place in the 
digestive tract of an infant, we can realize why babies 
should suffer so greatly from careless management of 
their food. 

Another tube had introduced into it some scrapings 
from the mouth of a child suffering with "thrush." 
Colonies of snowy-white germs appeared which, as they 



GERMS AND ANTISEPSIS. 63 

grew larger, became of a greenish color and spread with 
great rapidity. 

As object lessons serve to impress the importance of 
facts, these experiments serve to keep before us the 
importance of antiseptic precautions in the care of 
mother and child. 



CHAPTER VI. 

APPLICATION OF ANTISEPSIS TO CONFINEMENT 

NURSING. 

The use of antiseptics has almost entirely annihilated 
puerperal fever, commonly known as " child-bed " fever. 
This disease, as we know, is simply blood-poisoning, or 
septicemia, and is caused by the entrance through a 
wound of some poisonous material into the blood. In 
the simplest and most natural labors slight tears are apt 
to exist either about the external parts or about the 
neck of the uterus. There is always a wound inside of 
the uterus at the place where the placenta or after-birth 
was attached. In difficult labors there may be extensive 
wounds. 

Septicemia, or blood-poisoning, may be caused by a 
piece of placenta or blood-clot being retained in the uterus 
or birth-canal after the delivery, and there putrefying. 
It may also be caused by the patient's attendants having 
some poisonous material on their hands, instruments, 
or various appliances, and bringing these in contact 
with her wounds. Dirty hands, dirty finger-nails, unclean 
bed-pans, soiled clothing, etc., may be the cause of the 
trouble. Sponges should never be used in the lying-in 
room. Artificial sponges made of antiseptic cotton 

6 4 



ANTISEPSIS IN CONFINEMENT NURSING. 65 

enclosed in gauze may be substituted. The poisonous 
material which might be thus conveyed to the wounds 
of the lying-in woman must be guarded against by the 
most scrupulous attention to thorough cleanliness. 

Antiseptics are chemical substances which have the 
power of destroying the germs of putrefactive change or 
rendering them inert. They should, therefore, be sys- 
tematically used in all cases of labor to prevent septic 
germs from entering the wounds and giving rise to puer- 
peral fever. The antiseptics most generally employed 
in the maternity wards of the Woman's Hospital are 
creolin, carbolic acid, corrosive sublimate, permangan- 
ate of potassium, iodoform, chlorinated lime, boric 
acid, salicylic acid, oxalic acid, and tincture of iodin, 
according to the purpose for which each is designed. 

Solutions of corrosive sublimate should not be put 
into a metal dish, as the metal is thus corroded. The 
strength of all antiseptics is impaired by admixture with 
soap, so that one should not wash with soap in an anti- 
septic fluid. 

The following rules, indicating the antiseptic precau- 
tions observed in the maternity wards of the Woman's 
Hospital, will illustrate the precautions to be observed 
in all confinement nursing : — 

RULES TO BE OBSERVED BY NURSES.* 

I. The nurses on duty in the maternity wards shall 
have no communication with the general wards of the 

* Rules for preparation of the patient for labor are given elsewhere, 

5 



66 OBSTETRIC NURSING. 

Hospital. They shall be transferred to separate dormi- 
tories from those occupied by nurses on duty in the 
general wards. They shall give especial attention to 
personal cleanliness. 

2. They shall not touch the genital organs of a patient 
without having first thoroughly disinfected their hands. 
If their hands have come in contact with any foul dis- 
charges, this cleansing shall be accomplished as follows : 
ist. Thoroughly wash the hands with soap and water, 
scrubbing them well with a clean nail brush. 2d. Wash 
the hands in a saturated solution of permanganate of po- 
tassium, which colors them brown. 3d. Bleach the hands 
by washing them in a saturated solution of oxalic acid. 
4th. Rinse them thoroughly clean in boiled, filtered 
water. 5th.' Dip them for at least two minutes in a 
solution of bichlorid of mercury (corrosive sublimate), of 
the strength of from 1-1000 to 1-4000, or a solution of 
carbolic acid 2 per cent. The washing with perman- 
ganate of potassium and oxalic acid solution may be 
omitted where foul discharges have not been handled. 

3. Bottles containing solutions of corrosive sublimate 
1-1000, and carbolic acid 1-40, shall be placed on the 
washstand in every ward and delivery room. The solu- 
tions of permanganate of potassium and oxalic acid shall 
be kept ready for use in the bath-rooms. A small jar 
of carbolized vaselin shall be kept in each room. 

4. The dressings removed from a patient shall at once 
be carried out of the room and burned in the furnace. 

5. Immediately before the application of a fresh dress- 



ANTISEPSIS IN CONFINEMENT NURSING. 6j 

ing the nurse shall irrigate the external genitalia with 
either a corrosive sublimate solution 1-4000 or car- 
bolic 1-40, dry the parts with a piece of antiseptic 
lint, and then apply the occlusion dressing. (Direc- 
tions for preparation of antiseptic dressings are given 
elsewhere.) 

6. If the patient be a primipara (a patient with her 
first child), an iodoform suppository (30 grs.) shall be 
introduced into the vagina for a week, once daily. 

7. Metal and glass catheters shall be cleansed after 
each use by boiling, and kept in the intervals of use in a 
solution of carbolic acid 1-40. 

Vaginal nozzles shall be similarly treated. Each 
patient shall have a separate vaginal nozzle for her exclu- 
sive use. 

Soft rubber catheters, after a thorough cleansing with 
soap and water, shall be kept in a solution of corrosive 
sublimate 1-1000. 

Before using the catheter the nurse shall anoint it with 
a little carbolized vaselin. 

8. Syringes shall be cleansed after each use by hav- 
ing an antiseptic solution pumped through them. No 
vaginal injections shall be given during the lying-in, 
except after a direct order from the physician. 

9. If vaginal injections are required to be given when 
there is much fetid discharge from the vagina, an injec- 
tion of permanganate of potassium (a sat. solution) may 
be given in preference to the ordinary solution of 1-4000 



68 OBSTETRIC NURSING. 

corrosive sublimate or 1-40 carbolic acid. The nurse 
should always carefully report the occurrence of any 
odor in the discharge. 

10. All rubber sheets used about the patients' beds 
shall be washed in a solution of corrosive sublimate 
1-1000 or carbolic acid 1-20. 

11. All clothing removed from patients or their beds, 
soiled with discharges, shall be at once taken to the 
soak-tubs at the wash-house. When the blood has been 
soaked out in cold water they shall be placed in a disin- 
fectant solution of carbolic acid 1-20 for an hour, and 
then put through the ordinary processes of the wash, 
being thoroughly boiled. 

All soiled clothing shall be at once removed from 
patients' rooms. 

12. On the death of any patient in the maternity the 
body shall be at once wrapped in a bichlorid sheet 
( 1- 1 000) and removed to the mortuary. 

13. No one shall be allowed to visit the Hospital who 
is engaged in the dissecting rooms, or attending post- 
mortem examinations, or doing work in operative sur- 
gery upon the cadaver. No one attending infectious 
cases shall be admitted to the lying-in wards. 

No visitors shall be admitted to see patients in the 
maternity unless provided with a special pass from the 
physician in charge. 

14. Each room vacated by a patient shall be fumi- 
gated with sulphur before it is again occupied. 



ANTISEPSIS IN CONFINEMENT NURSING. 69 

The straw contained in the mattress upon which she 
lay shall be burned and the ticking boiled and then 
refilled with fresh straw for the next case. 

The bed, stands, etc., shall be wiped off with a solution 
of corrosive sublimate or carbolic acid when the room is 
reopened after fumigation. 

15. The mother's nipple and the baby's mouth shall 
be washed with a solution of boric acid (10-15 grs. 
to the ounce) before and after each nursing. 

16. The baby's cord shall be kept dressed with a 
powder containing salicylic acid 1 part to starch 5 
parts, which shall be changed as often as necessary. 

17. Immediately after delivery the baby's eyes shall 
be washed with a saturated solution of boric acid or one 
of nitrate of silver (1 gr. to the ounce) as directed. 

Symptoms of Infection. — Every nurse should know 
how to watch for symptoms which may indicate that 
there is an undue absorption of the antiseptic employed 
taking place. 

As to the selection of the antiseptic employed, the 
choice will be dependent upon the physician. If the 
nurse is obliged to depend upon herself, certain points 
must be taken into consideration. Thus, she must 
remember that patients with kidney disease are especi- 
ally susceptible to poisoning from the effect of corrosive 
sublimate ; anemic or bloodless patients bear both 
carbolic acid and corrosive sublimate badly ; children 
are particularly susceptible to carbolic acid. 

Poisoning from Antiseptic Agents in confinement 



JO OBSTETRIC NURSING. 

nursing most frequently occurs from the use of the anti 
septic agent in the vaginal douche. 

It is not unusual, when carbolic acid has been em- 
ployed for some time, to find the urine of a dark greenish 
color ; also to find that it contains albumen. One or 
more of the following symptoms may also be present : 
sickness or nausea, increased flow of saliva, difficulty 
in breathing, an anxious expression, sometimes fever, 
and always great weakness. 

Should any of these symptoms arise, the doctor 
should be at once notified. The patient may be stimu- 
lated by repeated small doses of brandy, and external 
friction should be employed. 

If carbolic acid has been swallowed, the first thing to 
do is to get rid of the poison by the administration of an 
emetic, as by copious draughts of mustard and water or 
salt and water; or the stomach should be washed out 
with the stomach pump. The easiest and one of the 
best things to use after this would be sweet oil or cotton- 
seed oil in large quantities. The patient's body must be 
kept very warm by hot blankets, and rectal enemata of 
beef-tea or milk and whiskey used. 

The mouth and bowels are most apt to be first affected 
by the absorption of corrosive sublimate. Any tenderness 
or sponginess of the gums must be noticed, or increase 
in the amount of saliva. Looseness of the bowels also 
requires the immediate discontinuance of the drug. 
Headache, dizziness, pains in the abdomen, lowering of 
temperature, sweats, and general prostration, with albu- 



ANTISEPSIS IN CONFINEMENT NURSING. 7 1 

minous and sometimes bloody urine, are other symptoms 
which may arise from the same cause. 

The drug must be stopped at once, the abdominal 
pain relieved by the use of poultices, a soothing diet of 
rice-milk or arrow-root, etc., employed, and such medi- 
cines given as the doctor may direct. 

If the drug is swallowed by mistake, the same treat- 
ment would have to be followed as in the case of carbolic 
acid poisoning, except that it is best at once to admin- 
ister the whites of two or three eggs to form an insoluble 
albuminate of mercury in the stomach, so that it may 
not be readily absorbed, but brought up by the use of a 
subsequent emetic. 

In mild cases, sleeplessness, headache, loss of memory, 
are the main symptoms, but in severe cases mania, mel- 
ancholia, or hallucinations may develop from iodoform 
poisoning. Sometimes there is considerable rise in tem- 
perature. The withdrawal of the drug and the support 
of the patient's strength constitute the main line of treat 
ment. Sometimes the use of about ten grains of cream of 
tartar, every hour for a time, has been found of advantage. 

Creolin, permanganate of potassium, boric acid, and 
salicylic acid are harmless, so far as toxic effects are 
concerned, but have not the same power. 

Chlorid of lime and chlorinated soda are of value as 
antiseptics because of the chlorin which is set free in 
their solutions. A small quantity, as from a half to one 
dram of the powdered chlorid of lime, may be dissolved 
in a pint or more of water. 



72 OBSTETRIC NURSING. 

The chlorinated soda is found in a preparation known 
as Labarraque's solution, of which a teaspoonful to a pint 
of water makes a solution strong enough for a vaginal 
injection. If to each ounce of this solution about four 
grains of permanganate of potash are added, the value of 
the solution as an antiseptic agent is greatly increased. 

Condy's fluid contains, as its active ingredient, per- 
manganate of potash, about eight grains to the ounce of 
water. A teaspoonful of Condy's fluid to the pint of 
water makes a solution suitable for a vaginal injection. 

It is not likely that poisoning would occur from the 
use of any of these agents. 

Permanganate of potassium and Condy's fluid are 
objectionable because of the brown stain they produce 
when dropped on clothing. 

Lysol is a coal-tar product now largely used as a dis- 
infectant in several surgical and lying-in clinics in Ger- 
many. It is claimed to be superior to carbolic acid, 
creolin, and other preparations of the same kind in its 
germicidal action, and it possesses powerful deodorizing 
properties. It is perfectly soluble in water, and its solu- 
tions are. soapy in character, removing all dirt (fatty or 
resinous spots, etc.), which does away with the necessity 
for soap in cleansing. It is used in y 2y I, and 2 per cent, 
solutions in midwifery and surgery. 

Rooms are generally disinfected, as after cases of 
septicemia, etc., by burning sulphur in the proportion of 
at least three pounds for every thousand cubic feet of air 
space. To secure any good results, close the apartment 



ANTISEPSIS IN CONFINEMENT NURSING. 73 

as closely as possible by stopping up all apertures 
through which the gas might escape by means of wet 
rags, which may be stuffed into the cracks around doors, 
windows, etc. The sulphur is put into a deep tin pan, 
which is placed upon two bricks, in a tub partly filled 
with water, in the middle of the room. A little alcohol 
may be poured on the sulphur, which is then set on fire, 
or a few live coals placed in the pan. The fumes should 
be kept in the apartment from twelve to twenty-four 
hours, after which doors and windows should be thrown 
open, and it should be subjected to free ventilation. All 
surfaces in the room must be then washed off with a 
carbolic solution (2 per cent.), or corrosive sublimate 
1- 1 000. 

Infected Underclothing, Bedding, etc., are best 
destroyed by fire, if of little value. To disinfect them 
we may employ — 

(a) Boiling for at least a half hour. 

(b) Immersion in corrosive sublimate solution 1-1000 
for three or four hours. 

(c) Immersion in a 5 per cent, carbolic solution for 
three or four hours. 

To avoid the discoloring effects of these solutions, 
clothing taken from them should be thoroughly rinsed 
out in clear w T ater before it is sent to the laundry. 

Outer garments which would be injured by boiling 
water or a disinfecting solution may be sterilized — 

(a) By exposure to dry heat at a temperature of 230 
F. (uo° C). 



74 OBSTETRIC NURSING. 

(&) By the steaming process in a suitable apparatus, 
such as is found in most hospitals. Clothing which can- 
not be thus thoroughly disinfected must be burned. 

Mattresses and Blankets should be disinfected in the 
same way. If these means are not available, mattresses 
may have their covering removed, and washed and 
boiled separately, the contents being immersed in boil- 
ing water for a half hour. 

Water-closets. — Solutions of copperas (sulphate of 
iron) or green vitriol, in the proportion of i}4 pounds 
to a gallon of water, are good and also very cheap for 
disinfection of water-closets, etc. 

Slaked lime and chlorid of lime may be used for 
privy vaults. 

Solutions of the chlorid of lime may be used also in 
water-closets, but there is danger of choking up the 
pipes if the solutions contain considerable deposit. Car- 
bolic acid solutions, 5 per cent., or bichlorid 1-1000 may 
be used instead of the above. 



CHAPTER VII. 
PREPARATIONS FOR THE LABOR. 

The relations between nurse and patient begin from 
the time the engagement is made for a nurse's attendance 
upon the confinement. 

The nurse is generally consulted beforehand as to the 
articles that will be needed at the time of the confine- 
ment and for the baby's outfit. Also, she is sometimes 
asked concerning the choice of a room for the labor and 
lying-in. 

The room is a most important consideration. It 
should be light, having the free entrance of sunlight, 
quiet, and well ventilated. It should not be too near a 
water-closet ; in fact, it is far better to have the water- 
closet out of the house entirely. There should be no 
stationary washstand in the confinement room ; or, if 
this cannot be avoided, the connection with the sewer 
pipe should be cut off, or the holes and escape pipe in 
the basin plugged up, the basin being kept filled with 
fresh water frequently changed. No slop jar or any 
vessel containing wash water, discharges, etc., should be 
allowed in the room. An ounce of prevention, in the 
way of keeping disease germs out of the room, is worth 
more than a pound of cure. 

75 



y6 OBSTETRIC NURSING. 

As regards the mother's dress, she should be advised 
to have a sufficient number of good-sized merino or 
flannel vests, to be able to change night and morning, 
so that the same vest shall not be worn both day and 
night. These are more readily changed if opened all 
the way down the front and fastened with tapes. The 
free action of the skin after delivery necessitates the use 
of flannel or merino to prevent chilling. If a long night- 
dress is worn, there is no necessity for the chemise. 
The night-dress, also, should be opened all the way 
down the front, as it renders easier for the patient the 
frequent changes which are necessary. Sufficient night- 
dresses and vests should be provided to make it possible 
for the clothing to be changed every day. 

Two or three abdominal bandages, also, should be pro- 
vided, either fitted to the patient's person or straight. If 
fitted, the bandages should be prepared when the patient 
is about six months pregnant, to be the right size after 
delivery. The bandages should extend from the pubic 
bone (the bone just above the external generative organs) 
to the breast bone, being about a half-yard wide and 
long enough to go once around the body and overlap one- 
third. It is best made of soft muslin doubled, the seams 
being turned in at the edges. Large safety-pins should 
be provided for fastening this bandage down the front. 

Where the breasts are large and pendulous, some 
bandage may be required for their support. An abdom- 
inal bandage may be used for this purpose, though it is 
rather wider than is necessary. 






PREPARATIONS FOR THE LABOR. 



77 



When the physician does not require the antiseptic 
dressings, now almost universally used, at least two 
dozen napkins of diaper linen should be provided for the 
mother, as very frequent changes of the napkin are 
essential during the first few days after the delivery, 
while the discharges are free. 

The antiseptic dressings used in the Woman's Hospital 
of Philadelphia are essentially the same as those recom- 
mended by Dr. Garrigues, of New York, known as the 
occlusion dressing. They consist of a piece of dry 



S\ 




Fig. 12. — Occlusion Dressing. (Dr. Garrigues.) 



patent lint, 6X8 inches, which has previously been ren- 
dered antiseptic by saturation in a solution of bichlorid 
of mercury i-iooo. This is placed, doubled in its width, 
so as to make a dressing, 3X8 inches, directly over the 
external organs of generation. This lint is covered by 
a piece of gutta-percha tissue, 4X9 inches, which is wet 
in a 1-4000 solution of bichlorid of mercury. 

These dressings are kept in place by a napkin of sub- 
limated cheese cloth, 18 inches square, folded to form a 



78 OBSTETRIC NURSING. 

diagonal 5 inches in width, within whose folds a pad of 
oakum is enclosed. The napkin is tightly fastened to 
the abdominal bandage, both anteriorly and posteriorly, 
by means of safety-pins, and the access of air to the 
vagina is thus prevented. These dressings are changed 
at least once in three hours, the dressing removed being 
at once burned. It is seldom necessary to continue the 
dressings longer than two weeks. They should be kept 
up, however, so long as the discharge persists. 

After the above statement, it will be seen that a nurse 
should have the patient obtain of each of the articles 
comprising the dressing the following quantity : Cheese 
cloth, 12 yards ; gutta-percha tissue, 1 yard ; patent lint, 
2 yards; oakum, ^ to I pound. 

The cheese cloth may be obtained at any dry-goods 
store, and prepared by first thoroughly washing with 
soft-soap and boiling, and then wringing it out in a solu- 
tion of bichlorid of mercury 1-1000. The patent lint 
should be rendered antiseptic in the same way. The 
gutta-percha tissue, patent lint, and oakum may be ob- 
tained at a drug store; the gutta-percha tissue may be 
more readily obtained directly from a rubber store, 
where the syringe also may be bought. 

In winter it is well for the mother to be provided with 
a " Nightingale wrap!' This is made of two yards of 
flannel of ordinary width. A straight slit, six inches 
deep, is cut in the middle of one side, the points so 
formed being turned back to form a collar. The corners 
farthest from this collar are also turned back to form 



PREPARATIONS FOR THE LABOR. 



79 



cuffs. The whole may be bound or pinked around the 
edge and fastened by means of buttons or ribbons. 

For the confinement bed the patient should provide 
two pieces of rubber-cloth a yard and a half square. 
For a single bed two rubber army blankets may be used, 
if, as in the maternity practice in the Woman's Hospital, 



Q 9 Q 9 




C 





Fig. 13. — Nightingale Wrap. 



it is desired to cover the whole bed. The arrangement 
of the bed will be explained in a later chapter. White 
rubber gum-cloth is the best when it is obtained in the 
piece. If the patient is poor, table oil-cloth may be 
used ; it is cheaper and answers the purpose as well ; or 
layers of newspapers tacked together will make very 
good temporary pads. 



SO OBSTETRIC NURSING. 

A piece of floor oil-cloth is the best protection for the 
carpet at the side of the bed. 

Rubber-cloth should never be used but for one con- 
finement. The rubber cracks when folded and put away, 
and no longer serves its purpose of protecting the bed. 
Then, too, it is very important to be sure that everything 
about the confinement bed is perfectly fresh and clean. 
Hence a rubber-cloth used for confinement should neither 
be borrowed nor lent. 

Sleeping on rubber-cloth makes a person perspire, 
hence it is desirable to get rid of it as soon as one can. 
It is seldom necessary to use it after the fifth or sixth 
day. 

Other articles necessary to have on hand will be half 
a dozen old sheets, about a dozen towels, a new syringe 
(a fountain syringe, large size, is the best), a bed-pan 
(French pattern), nail-brush, white Castile soap, a jar of 
cosmolin or vaselin. 

I desire, in this connection, to emphasize the fact that 
the syringe should be a new one. This is an antiseptic 
precaution. Hence advise the patient strongly against 
the use of any syringe which may have been used for 
other purposes, however well it may work. Of course, 
the borrowing of such an article from a neighbor or 
friend should be strongly discountenanced. 

Regarding the baby's clothes, if they are made too elab- 
orate they will not be washed often enough, hence they 
should be plain. As the depressing influences of cold 
are very injurious to babies, the clothing should be warm, 



PREPARATIONS FOR THE LABOR. 8 1 

hence a flannel garment with long sleeves and high neck 
should be worn next the skin, the thickness varying 
with the season of the year. The activity of the life 
processes make it important that every organ of the 
body shall be unimpeded in its action and free from 
pressure, hence the clothes should be very loose and light 
in weight. 

The only articles absolutely needed to constitute an 
outfit are, 1st, a soft flannel shirt, with high neck and 
long sleeves, opened in front. This is better than the 
merino vests or the knit shirts, which shrink on washing, 
and are then difficult to put on and take off. 2d. A binder, 
or bandage of fine, soft flannel, four inches wide, and 
long enough to go around the abdomen once and lap 
over about one-third. This should be made without a 
hem, the raw edge being overstitched to prevent ravel- 
ing. The binder is best fastened by means of two pieces 
of tape attached to one of its edges. 

This arrangement does away with the necessity for 
pins in fastening the binder, the pieces of tape being 
simply wound around the body to secure the binder, 
and tucked in at one edge. Some prefer the knitted 
wool band, made of single zephyr and knitted in the 
ribbed stitch, as wristlets or mittens are often knit, to 
permit of greater elasticity. These bands are made a 
little narrower in the center than at either extremity, so 
as to be held in place better. They are made perfectly 
circular, just like a wristlet, and are so elastic that they 
can readily be drawn up over the limbs and adjusted 
6 



82 OBSTETRIC NURSING. 

to the body. 3d. A napkin of cotton or linen diaper is 
the best ; Canton flannel makes a very poor baby's nap- 
kin, as it becomes stiff when washed. Napkins arc gen- 
erally made too large for a new-born baby, and require 
to be folded into too many thicknesses. A napkin which 
when folded once is half a yard square, is of ample size. 
The number of napkins supplied should be generous, so 
as to permit of frequent washing and thorough airing. 
Napkins should always be fastened by safety-pins. For 
the protection of the outer garments from dampness due 
to frequent urination, it is well to have a second napkin 
folded and laid beneath the baby's hips. The use of 
rubber-cloth over the napkin for this purpose is much 
to be condemned, as it overheats the parts and makes 
the skin tender. 4th. A flannel slip of heavier or lighter 
texture, according to the season, serves the purpose both 
of petticoat and dress. This should be made just long 
enough to cover the baby's feet — about twenty-five 
inches from neck to hem, and should be fastened in front. 
The ordinary fashion of making a baby's clothes very 
long is objectionable because of the greater weight of the 
clothes preventing free movement of the child's limbs 
and the development of its muscles. The object of 
fastening the clothing in front rather than in the back 
is to avoid the necessity of the baby's lying on the un- 
even surfaces produced by buttons, tapes, and hems, 
which no doubt are often a source of discomfort to its 
tender skin. 5th. Knit woolen socks are necessary to 
keep the baby's feet warm, and it is well to have them 



PREPARATIONS FOR THE LABOR. 83 

extend pretty well up the leg, reaching even to the knee, 
as cold feet are often an exciting cause of colic. 

The above are the only essential articles of clothing 
for a baby. Should the mother prefer, for the sake of 
effect, to see her baby in white muslin, a slip of muslin 
can be worn over the flannel slip. These garments do 
away with all waistbands and the constriction of the chest 
thereby induced. Should the garments be made with 
waistbands, they should be supported from the shoulders 
by means of straps, or armholes should be made in the 
bands, just as in the case of an older child; they will 
not need then to be drawn so tightly around the child 
to be retained in place. 

A heavy blanket is not needed to wrap the baby in, 
in a room at the temperature of the lying-in room — from 
68° to yo° ; but should it be carried from one room to 
another, or when it sleeps, a blanket, or some wrap, 
ranging in weight with the season, will need to be 
thrown over it. 

When a baby has but little hair on its head, and shows 
a tendency to catch cold readily, a plain cambric or light 
flannel cap may be employed as a head covering. This 
is a preventive against catarrhal troubles affecting the 
nose and throat. 

A recent journal has described an outfit for babies 
which has obtained much favor among mothers. It is 
called, I believe, the " Gertrude Suit" and consists of 
three garments : The first, or undergarment, is made of 
soft flannel, and is long enough to extend from the neck 



84 OBSTETRIC NURSING. 

to ten inches below the feet. The next garment, cut in 
the same way, but half an inch larger and five inches 
longer, is made of muslin. Over these comes the " slip," 
also Princess style, and the only one of the garments 
with long sleeves. (This is the most objectionable fea- 
ture of the suit; a baby's arms should be well covered.) 
It has a longer skirt than either of the other garments. 
All are fastened behind by small buttons. These three 
garments are put together and all slipped on to the baby 
at one time, facilitating the process of dressing very much. 

Tn our opinion, however, this suit has not the same 
advantages as that worn in the Maternity of the Woman's 
Hospital of Philadelphia, and first described. The fasten- 
ing of the clothing in front, the fewer number of articles 
comprising the wardrobe, and the fact that they may be 
very easily taken off and put on, while they meet all the 
requirements of warmth, looseness, and lightness, make 
this outfit preeminently a comfort to the baby. 

It is well to provide a lap-protector for the mother or 
nurse who shall have the baby in charge. This may be 
made of any thick wash material, and if shaped like a 
pillow-case, and fastened at one end by buttons, a piece 
of rubber sheeting can be slipped inside of it. The 
rubber can be slipped out and the case washed as often 
as necessary. 

The articles provided for the baby-basket may be the 
following : — 

Three or four pieces of linen bobbin, about eight 
inches long. 



PREPARATIONS FOR THE LABOR. 85 

A pair of blunt-pointed scissors. 

Large and small safety pins. 

Several small squares of soft linen, about four inches 
square, for dressing the cord, and two inches square, for 
washing the eyes and mouth. 

A soft hairbrush. 

A powder-box and puff, with lycopodium or fine 
starch powder. (The scented powders are often irritat- 
ing-) 

A small jar of cold cream. 

Two soft towels. 

A full suit of clothes, as described above, for the 
baby. 

A woolen shawl or wrap. 



CHAPTER VIII. 

SIGNS OF APPROACHING LABOR— THE PROCESS OF 

LABOR. 

Certain changes take place during the latter part of 
the ninth month which indicate that labor is approach- 
ing. One of these is the sinking of the abdominal en- 
largement. The upper part of the womb, which has at the 
beginning of the ninth month been high enough to reach 
the pit of the stomach, comes down gradually to a point 
about midway between the extremity of the breast bone 
and the navel. This sinking of the womb is known as 
if descent" or " settling " of the child, and indicates that 
the head of the child, which is ordinarily the part to be 
born first, has stretched the lower part of the womb and 
is finding its way into the cavity of the pelvis, through 
which it must pass in the birth. Great relief to the 
mother results from this descent of the womb, as the 
lungs are no longer pressed upon to the same extent as 
before. The change in the position of the womb pro- 
duces, however, an increased amount of pressure on the 
lower portions of the body. Swelling of the lower limbs 
is apt to result in consequence of this, and walking is 
rendered difficult. Piles, or hemorrhoids, are apt to form, 
and irritability of the bladder to exist. 

86 



THE PROCESS OF LABOR. 87 

During the last two weeks of pregnancy patients are 
apt to suffer from what is known as "false pains!' These 
are cramp-like pains, so much like labor pains that 
patients are often deceived by them, and led to imagine 
that the labor is really coming on. They are called 
" false pains" to distinguish them from the pains of labor, 
which are known as " true pains!' The way to distin- 
guish between the two kinds of pains is to observe 
whether there is any regularity as to the time of their 
occurrence ; also, whether the interval grows shorter, 
and whether, with this shortening of the interval, the 
pains grow stronger. " False pains" are irregular in 
their occurrence, while "true pains," though starting 
perhaps at quite long intervals, as three-quarters of an 
hour or a half-hour apart, gradually come nearer to- 
gether and grow stronger. " False pains," also, are 
generally located in the abdomen. "True pains" more 
frequently start in the back, coming forward to the abdo- 
men and extending down the thighs. A strong "pain" 
is apt to be followed by one or two weaker pains. A 
nurse, if in doubt as to whether the pains are real labor 
pains or not, should have the physician sent for, who 
will make an examination to learn what the condition 
of the parts may be. A sign that makes it probable that 
the labor is really coming on is the appearance of what 
is known as the "show" a discharge of mucus, tinged 
with blood, which comes from the mouth of the womb, 
and indicates that the stretching of the mouth of the 
womb is taking place. 



88 OBSTETRIC NURSING. 

The whole process of labor is divided into three stages. 
The first is the stage of dilatation, when the mouth of the 
womb is stretching so as to allow the child to pass 
through it. With women who have never borne chil- 
dren this stage lasts on an average fifteen hours, while 
it is a very variable period for those who have previously 
borne children — sometimes lasting but three or four 
hours ; the average time given is from seven to eleven 
hours. 

The second stage of labor begins after the completion 
of the stretching of the mouth of the womb and ends 
with the birth of the child. For women with their first 
birth, this period lasts from an hour to an hour and a 
half; with others, from twenty minutes to an hour. 

The third stage of labor includes the interval between 
the expulsion of the child and the coming away of the 
afterbirth — on an average a half an hour or twenty 
minutes. 

The time for the entire labor, in a case where it is the 
first birth, is about seventeen hours. In cases where 
other children have previously been born, the average is 
from eight to twelve hours. 

The "bag of zvaters" is a sac of membranes in which 
the child is enclosed. Within this bag is found a liquid 
in which the child floats. The presence of this liquid 
between the child and the walls of the womb serves to 
protect it from the effect of falls or blows to which the 
mother may be subjected, and favors the regular devel- 
opment of the child. When labor begins with the 



THE PROCESS OF LABOR. 89 

stretching of the mouth of the womb, a small portion of 
this sac is pushed out like a wedge beyond the rim of 
the dilating orifice, and helps thus in the dilatation. 
When the waters break early, labor is much more tedious 
because the even pressure of the bag of waters on the 
mouth of the womb is lost, and the stretching cannot, 
therefore, go on so rapidly and easily. As the mouth 
of the womb opens, the pouch formed by the bag of 
waters is oushed further and further out into the vagina, 
the pains become stronger, and the pouch at last bursts, 
letting the water escape. This is " the breaking of the 
waters, " called by physicians the " rupture of the mem- 
branes," and it should not take place before the mouth 
of the womb is fully open. 

Labor, however, sometimes begins with this loss of 
water, as has been said in the chapter on the Accidents 
of Pregnancy. 

The pains of the first stage of labor are cutting, grind- 
ing pains, very hard for the patient to bear, and causing 
her to be nervous and irritable. 

The cries made by the patient during the first stage of 
labor are very different from those of the second stage. 
They are cries of complaint and suffering, while during 
the second stage they are rather groans accompanying 
a bearing-down effort on the part of the patient. The 
pains of the second stage are called " forcing " or " bear- 
ing-down pains." An experienced woman will know, 
as soon as these pains begin, that the doctor should be 



90 OBSTETRIC NURSING. 

on hand as soon as possible ; and she should send him 
a message which will lead him to realize the necessity 
for coming at once. 

The pains during the second stage increase in strength 
and frequency ; the patient holds her breath and bears 
down forcibly with each pain. The effort causes her 
to become flushed and heated, and to break out into 
perspiration. 

During this time the head of the child is forced down 
the middle passage, or vagina, to the external opening. 
At the end of each pain the head goes back a little, so 
that the birth-track may be very gradually stretched. 
With women who have previously borne children there 
is often so much relaxation of the tissues forming this 
passage-way that the head of the child may be expelled 
by a single pain. This sudden birth of the head often 
causes very serious tears. 

After the external opening has been sufficiently 
stretched by the slow advance of the head, it gradually 
works out altogether, and then the worst pain is over. 
There is then a short interval of rest before the re- 
mainder of the body is born, the shoulders coming first 
by a strong pain, after which the lower part of the 
body easily slips out. 

The contraction of the womb, or "pains," now cease 
altogether from five to twenty minutes or even half an 
hour, when there is again a little pain and the afterbirth 
comes. 



THE PROCESS OF LABOR. 9 1 

The above description is an account of what labor 
should be if perfectly natural. There are many emer- 
gencies which may arise in any case, hence, for the sake 
of the patient and nurse, every effort should be made, 
even in what promises to be a normal case, to have the 
doctor on hand in time. 



CHAPTER IX. 
DUTIES OF THE NURSE DURING LABOR. 

With the occurrence of the symptoms which indicate 
the onset of labor, the nurse, if not already in the house, 
should be immediately sent for. 

A nurse should give very prompt attention to such a 
call, and lose no time in getting to the patient, as many 
women pass through the different stages of labor very 
rapidly. 

On arriving at the patient's house, the nurse should 
put on her working-clothes , which should always be 
scrupulously clean and of wash material. The uniform 
worn by the nurses of the Woman's Hospital, of Phila- 
delphia, consists of a blue and white striped seersucker 
dress, very plainly made ; a large plain white apron, with 
bib, well protecting the dress; over-sleeves, of same 
material as apron, for the protection of the dress- 
sleeves, and a white muslin Normandy cap. This makes 
a plain yet attractive dress — which is a matter of con- 
siderable importance to the patient, who gets her first 
impressions of her nurse through her personal appear- 
ance. 

Woolen dresses, or those made of any material which 

92 



DUTIES OF THE NURSE DURING LABOR. 93 

will not bear frequent washing, should never be worn by 
a nurse. There is always the possibility — in fact, the 
probability — of such a dress having been worn during 
her attendance upon some previous case of illness, in 
which case it would greatly endanger the patient. The 
feeling of the wash dress as it comes in contact with the 
patient's skin, when the nurse lifts her or works about 
her, is much more agreeable than that of woolen stuffs. 
Then, too, it is more business-like, looks more like work, 
and gives the patient the comfortable feeling that a nurse 
means to help her, rather than to sit around as a fine 
lady, attending simply to the daintier parts of attendance 
upon the sick. I introduce this subject here because I 
find that many graduate nurses, in breaking their direct 
connection with their training-schools, set aside as a 
matter of small moment this requirement concerning 
dress — a requirement in which a most important prin- 
ciple is embodied and which demands the hearty support 
of every truly scientific nurse. 

Another important point I wish to mention here, and 
that is, that a nurse should learn to dress herself quickly, 
so that she can slip into the necessary garments in a very 
few minutes, and thus, by her promptness in reporting 
for duty, awaken the confidence so essential to her man- 
agement of patients. 

On entering the room where the patient is to be found, 
while exchanging the necessary greetings, the nurse 
should exercise her powers of observation and rapidly 
take in the state of affairs, forming her opinion as to how 



94 OBSTETRIC NURSING. 

far the labor has probably progressed. Should " pains" 
be occurring, she will recognize, from what has been 
said in a preceding chapter of the pains characterizing 
the different stages of labor, whether the patient is really 
in labor or not, also, how much time is probably left for 
the making of preparations. She can learn from the 
patient, in the intervals of her suffering, when the pains 
first began, how often they occur, whether the waters 
have broken, etc., so that she may know what message 
to send the doctor, should the necessity exist for so 
doing. After this duty has been performed, if labor has 
really begun, the nurse should give herself to the prep a- 
ration of the patient and the room for the confinement. 

Preparation of the Patient. — The nurse should 
inquire of the patient whether her bowels have been 
freely moved recently. If not, a simple enema of soap 
and water may be given for the purpose of clearing out 
the lower bowel and making the second stage of labor 
easier and cleaner. 

Inquiry should be made as to whether the patient has 
passed water freely. If not, she should be urged to make 
the attempt, and, if not successful, the physician should 
be notified. 

It is desirable, if there is time, to have the patient 
take a full warm bath and put on entirely fresh clothing. 

A vaginal injection of some antiseptic solution may 
then be given, and the parts about the external genera- 
tive organs washed off with an antiseptic solution. In 
the Woman's Hospital the vaginal injection consists of a 



DUTIES OF THE NURSE DURING LABOR. 95 

solution of bichlorid of mercury 1-8000. The external 
parts are washed off with a similar solution of 1-2000 
or 1-4000. 

Preparation of Antiseptic Solutions. — Tablets of 
bichlorid of mercury may be obtained at any apothe- 
cary's, one of which, if added to a pint of water, will 
give, as a rule, a solution of 1-1000, from which solu- 
tions of varying strength may be made up by the addi- 
tion of more or less water. Thus, on adding seven parts 
of water to one part of the bichlorid solution 1-1000, a 
solution of 1-8000 may be obtained. It is always 
desirable that the nurse should have a little porcelain or 
agate-ware gill measure, by which she can readily and 
quickly prepare these solutions. If tablets cannot be 
obtained, powders of 7^ grs. each of bichlorid of mer- 
cury, if added to a pint of water, will give a solution of 
1- 1000. 

Creolin, a coal-tar preparation, four times stronger in 
its antiseptic properties than carbolic acid, may be used 
in place of bichlorid of mercury. To make this, y 2 to 
1 dram of the creolin should be added to the pint of 
water. Creolin, though not so strongly antiseptic as 
bichlorid of mercury, has greatly come into favor of 
late, both because it does not have the same corroding 
effect on instruments which may be used, and because 
there is less liability of poisoning than in the use of 
bichlorid of mercury. An objection has been raised to 
the use of creolin for vaginal injections, as it is claimed 
that its admixture with blood produces a tarry precipi- 



96 OBSTETRIC NURSING. 

tate. The coagulation of albumen in vaginal discharges, 
by the action of corrosive sublimate, is similarly claimed 
to deteriorate the value of the latter as an antiseptic 
agent. In cases where there is excessive discharge it is 
better, therefore, to substitute a solution of permanga- 
nate of potassium, or carbolic acid. 

A nurse should never lose sight of the fact that the 
corrosive sublimate (bichlorid of mercury) tablets are a 
deadly poison, hence there should be no neglect as to 
care in their handling. 

Carbolic solutions are used in place of either of the 
above by some physicians. A two-per-cent. solution of 
the latter maybe made up by adding 2]/ 2 drams to the 
pint of water. 

When the patient seems to be in active labor, the nurse 
should keep her lying down until after the physician has 
made an examination. He will then state whether the 
patient may sit up or walk about the room. 

Because of her long confinement to bed the hair of 
the patient should be arranged so that it will be most 
comfortable and not readily tangled. The best arrange- 
ment is that of parting the hair down the back of the 
head and braiding it into two plaits — one behind each 
ear. This leaves a smooth surface at the back of the 
head to lie upon. 

The outfit of the patient during the labor should con- 
sist of a merino vest, long night-dress, a pair of large, 
roomy, open drawers, and a pair of stockings. While 
walking about the room, and until the second stage of 



DUTIES OF THE NURSE DURING LABOR. 97 

labor begins, she can wear a wrapper over the rest of her 
clothing and have on a pair of bedroom slippers, which 
can be easily slipped off when she needs to lie down. 

The patient should be told by the nurse of the neces- 
sity for an examination by the physician, particularly if 
this is her first labor. When the physician comes, the 
patient should be placed on the bed, near its edge, lying 
on her back or side, as he may prefer, with her limbs 
drawn up toward the abdomen. Her clothing should be 
lifted above the hips, and a sheet, or some light covering, 
used to protect the lower part of the body from ex- 
posure. A chair should be placed for the physician on 
the same side of the bed, close to its edge, facing the 
patient as she lies ; a jar of cosmolin or vaselin should 
be brought him, and all the necessary materials provided 
for the proper cleansing of his hands both before and 
after the examination ; soap, nail-brush, warm water and 
towels, and some disinfectant solution, as a bichlorid of 
mercury solution of the strength 1-2000, or creolin, a 
dram to the pint of water.* 

The preparation of the room and bed will next require 
the nurse's attention. 

These preparations should be made as quietly as pos- 
sible. The nurse should have learned beforehand where 
things are, and she should have had them so arranged 
that but little will need to be done at the time, except to 



* Some physicians prefer the use of a saturated solution of permanganate 
of potassium, regarding it as a more thorough antiseptic. 
7 



98 OBSTETRIC NURSING. 

put them where they will be most convenient for use. 
It is well, if the patient is walking about, to have her go 
into the next room while the bed is made up. 

A single bed is always the most convenient in the man- 
agement of a patient, but such are rarely found in private 
houses. The preparation of a single bed would be as 
follows : First, the mattress — preferably of hair — covered 
by a pad and rubber-protective across the middle of the 
bed, or covering the bed entire. (Rubber army-blankets 
are used in the Woman's Hospital for this purpose.) 
The under sheet covers this rubber, and a draw-sheet — 
a sheet folded four times in its length and placed across 
the portion of the bed upon which the hips would rest — 
comes next. (The folded side of the draw-sheet should 
be toward the head of the bed.) This constitutes the first 
dressing, or what is known as the "permanent bed!' The 
different articles constituting this dressing are securely 
fastened down by safety-pins. Over the " permanent 
bed " comes the " temporary bed" consisting of a second 
gum blanket, covering the entire bed, a second under- 
sheet and draw-sheet. Covering these are the upper 
sheet, blanket, and spread. 

After the confinement, the " temporary bed " can be 
drawn from under the patient, leaving her lying on the 
" permanent bed." The change is accomplished with 
much greater ease for both patient and nurse than the 
changing of the various articles separately. 

The double bed found in most private houses is ar- 
ranged as follows : First, the ordinary dressing of the 



DUTIES OF THE NURSE DURING LABOR. 99 

bed, the hair-mattress, pad, rubber-protective, under- 
sheet, and draw-sheet. Upon top of this dressing, at the 
lower right-hand corner of the bed, a " temporary dress- 
ing " should be arranged, about a yard and a half square, 
consisting of a rubber protective, or the paper pad before 
described, securely fastened down to the bed beneath, 
and covered, if rubber, simply by a folded sheet, likewise 
fastened down by safety-pins. If the paper pad is used, 
an old comfortable or blanket will be needed beneath the 
sheet. The pillow for the patient should be placed at the 
upper and inner corner of this square. After the delivery, 
she can be lifted to the upper part of the bed, and the 
" temporary dressing " removed. 

The sheet, blanket, and spread which are to serve as 
her covering after the delivery can be kept from soiling 
during the labor if folded upon themselves several times 
and carried to the extreme edge of the left side of the 
bed. Another sheet and blanket may be used as tem- 
porary covering during the delivery. It is so important 
that a patient shall be moved as little as possible imme- 
diately after the labor, because of the tendency to bleed- 
ing produced by motion, that the nurse should study 
carefully the best methods of protecting patient and bed 
from soiling, so that it will be necessary to do but little 
in the way of changing the clothing. 

The piece of floor oil-cloth must be spread at the side 
of the bed, extending from a foot to a foot and a half 
under the bed. 

There should be a bureau with a set of drawers, or a 



IOO OBSTETRIC NURSING. 

closet, with shelves, in the room, given up to the nurse 
for the keeping of the various articles she may need, and 
these articles should be conveniently arranged so that 
there may be no confusion in obtaining them when re- 
quired at anytime. One drawer or shelf should contain 
sheets ; another towels and napkins and soft, clean muslin 
or linen rags, to be used as napkins during the delivery; 
a third should contain changes of underwear for the 
patient, and a fourth the baby's wardrobe. 

A change of clothing for the mother should be placed 
— if it is warm weather — in the sun by a window ; if in 
winter, by the register or stove, so as to be dry and warm 
should it be needed. 

The baby's suit should in the same way be aired and 
warmed. The baby's basket should be placed on a chair 
or stand near the register, with all the necessary articles 
for its toilet and bath — a baby's bath-tub or an ordinary 
foot-tub, soft towels, nurse's flannel bathing-apron, a little 
rendered lard in a jar, etc. Two pieces of bobbin, each 
eight inches in length, should be put in a little vessel 
containing some bichlorid solution, 1-4000. These, 
with a pair of blunt scissors, should be placed where 
they can be conveniently reached for the tying of the 
cord. Some small squares of soft muslin or linen should 
be placed where they will be convenient for the imme- 
diate cleansing of the child's eyes after expulsion of the 
head. A flannel blanket or good warm flannel petticoat 
should be provided for receiving the child upon its birth. 
The baby's crib should also be prepared for its reception. 



DUTIES OF THE NURSE DURING LABOR. IOI 

Beneath the bed there should be two chambers — one 
for urine and one for the afterbirth, or a tin basin may be 
provided for the latter. 

Some receptacle should be in readiness for the doctor's 
instruments , should they have to be used. The small 
pitcher which ordinarily accompanies the modern 
chamber sets serves this purpose very nicely. 

A vessel for the patient to vomit in should be on hand 
— a chamber, or even a chamber-lid, will do very well. 

A basin filled with a warm solution of bichlorid of mer- 
cury, 1-4000 or 1-2000, should stand near the bed, so 
that the nurse or physician may repeatedly cleanse the 
external organs of generation of all discharges during 
the progress of the labor. The solution in this basin 
should be frequently changed. 

A sufficient number of soft linen or muslin rags will 
also be necessary for this purpose. 

Agate, porcelain, or china basins are necessary when 
bichlorid solutions are used. For creolin ordinary tin 
basins will do. 

The nurse should never allow anything from the 
kitchen to be pressed into service for such an occasion. 
The indiscriminate use of pans, basins, cups, and saucers 
is certainly vulgar, to say the least. The •" eternal fitness 
of things " should never be lost sight of. 

A urinal, or a soap-cup, which is a good substitute ; a 
silver catheter, and an English rubber catheter, No. 8 or 
No. 9 ; a bed-pan, and the other receptacles for the 



102 OBSTETRIC NURSING. 

various purposes above referred to, may be placed for 
convenience beneath the bed. 

A towel-rack near by should contain at least half a 
dozen fresh towels. 

A few napkins, a supply of soft rags, a jar of cosmolin, 
a waste-bucket or slop-jar, with a lid, should be found in 
the room ; and an abundant supply of hot and cold water. 

As soon as the patient is known to be in labor, the 
nurse should go to the kitchen to see that the fire is 
good, and that plenty of water is put on to boil. An 
arrangement should also be made by which some mem- 
ber of the family will be prepared to respond to the 
nurse's call for more hot water when it is required. 
The abdominal bandage for the patient, with a set of the 
dressings and a pin-cushion containing safety-pins, should 
be placed on the stand beside the bed. 

A bottle of whisky or brandy, and one of hartshorn 
should be provided. 

A pitcher of cool water and a tumbler should be 
found in the room, as the patient may need a refreshing 
drink during the progress of the labor. A feeder is 
best provided for the patient's use, as she can then drink 
lying down. 

The arrangement of the patient 1 s clothes to keep them 
from soiling during the expulsive stage of labor will 
require some care on the part of the nurse. The night- 
dress or vest should be folded or rolled up beneath the 
arm-pits and fastened with safety-pins over the right side 



DUTIES OF THE NURSE DURING LABOR. IO3 

of the chest. If the patient wears large drawers, no 
further protection than the cover-sheet may be necessary. 
Some prefer having a sheet adjusted around the waist, 
above the abdomen, and pinned under the clothing to 
the right side, the long end of the sheet which remains, 
and which should be the anterior part, is plaited up and 
fastened also beneath the right arm by means of safety- 
pins. The sheet thus resembles a skirt opened at the 
right side. 

During the Early Stage of Labor the nurse will 
need to encourage the patient, and by a sensible, quiet, 
yet cheerful bearing keep her strong. It is of no use 
for patients to hold their breath and bear down during 
each pain in this stage, and nurses should never urge 
their patients to do so. It should be left to the physician 
to decide when bearing-down efforts are desirable. The 
pressure of the nurse's hand upon the back during a 
pain often gives great relief to the patient, while the 
occasional bathing of the face and hands with cold water 
is refreshing. Frequent sips of cold water may be per- 
mitted. 

Nourishment in the form of beef-tea, gruel, milk, and 
tea may be given from time to time if the labor be long. 
No stimulants should be given without the direction of 
the physician. 

Vomiting is a troublesome though not necessarily a 
dangerous symptom during delivery. In fact, the relaxa- 
tion it produces is often desirable. If it is excessive, 
however, a little iced soda water may check it. 



104 OBSTETRIC NURSING. 

Cramps in the lower limbs are a very frequent accom- 
paniment of the second stage of labor. Relief may be 
obtained by stretching the limb straight out, gently rub- 
bing the painful muscles, or grasping and holding them. 

Friends and Neighbors should, if possible, be ex- 
cluded from a confinement room. Their injudicious 
tales and expressions of sympathy are often absolutely 
painful. The nurse has to manage this with great tact. 
She can generally succeed best by stating to the friends 
that it is the physician's wish she should do so, and her 
relations toward the physician require that she should 
implicitly observe his directions. If the nurse does not 
allow herself to become familiar with her patients, but 
maintains a quiet dignity in the carrying out of her 
directions, her requests will generally be observed. 

Tact is a magic w r and by which human beings can 
accomplish miracles in the way of subduing the obsti- 
nate. Happy is the nurse who possesses it ! The best 
rule for acquiring it is the Golden Rule, " Do unto others 
as you would that they should do to you." A strict 
observance of this will insure a kindness of tone and 
manner in the making of requests which will win con- 
sent when it would not otherwise be granted. 

Duties of Nurse. — One of the most important duties 
of the nurse during the confinement is the frequent 
changing of napkins, draw-sheets, towels, etc., used about 
the patient. Also the frequent renewal of the antiseptic 
solutions to be used about her, or for the doctor's 
hands. 



DUTIES OF THE NURSE DURING LABOR. IO5 

Antisepsis means, literally, " against poisoning," and 
implies the careful removal of all sources of poisoning, 
such as would come from decomposing blood and dis- 
charges or dirty articles. The physician's and nurse's 
hands, therefore, require a special preparation for the 
labor in their thorough disinfection. During the course 
of the labor the hands should be thoroughly cleansed 
with a bichlorid solution whenever they have touched 
anything unclean, or whenever they come in contact 
with the genital organs. 

Position for Delivery. — The patient may be deliv- 
ered on her back or lying on her left side. When the 
physician desires the change of position, the nurse must 
help the patient to turn on her side and bring her hips 
close down to the edge of the bed. The upper or right 
limb will then have to be supported by the nurse, in 
order to well separate the thighs until the delivery is 
affected. (When there is insufficient help, a pillow may 
be used between the knees.) She will have to get on 
the bed close to the patient for this, and hold the leg at 
knee and ankle. After the child has come, she should 
help to turn the patient in the bed, bring a flannel wrap 
to put the baby in as it lies on the bed before the tying 
of the cord, and throw a covering over the mother's 
chest. She should then wipe the baby's eyes with a fine, 
soft piece of linen dipped in tepid water, or a saturated 
solution of boric acid; should bring the doctor the scis- 
sors and bobbin, and have ready a sheet for receiving 
the child and a vessel for the afterbirth. She should 



106 OBSTETRIC NURSING. 

hold the sheet doubled upon her outstretched arms, the 
side toward her being held up by her chin. On receiv- 
ing the baby with its flannel covering, she allows the edge 
of the sheet held up by her chin to drop down over the 
child. She then folds over the hanging ends, so as 
thoroughly to cover the child, and places the little bun- 
dle in a crib, to await further attentions, until the mother 
has been made comfortable. Should the child breathe 
imperfectly, the physician will give it his own attention 
or direct the nurse what to do. 

Disposal of Afterbirth. — The vessel containing the 
afterbirth, if the latter has been detached from the child, 
may be placed temporarily under the bed, to await the 
physician's examination. If the cord has not yet been 
tied, the vessel may be put in the crib with the baby. 
Many physicians do not tie the cord or navel-string 
until there is no further pulsation in the vessels. 

Attentions after Labor. — Should the physician not 
desire to do so, the nurse should next attend to the 
cleansing of the mother's external parts by means of soft 
cloths dipped in a solution of bichlorid of mercury 
1-4000. 

Many physicians make a practice of using a vaginal 
injection of some disinfectant solution immediately after 
delivery. It will be the nurse's duty to prepare this 
should it be called for. The " temporary dressing " 
should be removed from the patient, and she should be 
gently lifted on to the upper portion of the bed. The 
binder and dressings must next be applied. 



DUTIES OF THE NURSE DURING LABOR. IO7 

" The binder must be rolled up to half its length, and 
the rolled portion passed beneath the patient's back. It 
is then caught on the other side and unrolled, straight- 
ened so as to be free from wrinkles, and made to encircle 
the hips tightly. The overlapping ends are then fastened 
together by means of safety-pins down the front." The 
middle portion of the bandage should be tightened first, 
as the firmest pressure should be directly over the 
upper portion of the womb. The lower portion of the 
bandage is fastened next, and the pins in the upper 
portion placed last, as this does not need to be so firmly 
applied. 

The antiseptic dressings should next be applied in the 
order described in the preceding chapter. The napkin 
is spread out and fastened to the abdominal bandage 
anteriorly, so as to fit over the convexity of the upper 
portion of the external organs of generation and extend 
from groin to groin. Posteriorly it is fastened to the 
abdominal bandage by but one safety-pin. This makes 
an " occlusion dressing." 

The patient's body-clothing should then be unfastened 
and drawn down (her drawers and stockings should 
have been removed with the " temporary dressing"). 
The coverings of the bed are drawn up over her, and she 
is allowed to lie quietly until the nurse cleans up the 
room and makes preparations for washing the baby. 

The physician generally remains with the patient an 
hour after the delivery, taking her temperature and 
pulse, and watching the condition of the womb, to insure 



108 OBSTETRIC NURSING. 

against danger of hemorrhage from want of proper con- 
tractions, 

After the doctor leaves, this duty devolves upon the 
nurse, who should examine the dressings frequently to 
see that the bleeding is not too profuse, and place her 
hand over the lower part of the abdomen to feel the 
womb, which, if properly contracted, should be a round, 
hard body about the size of a child's head, immediately 
above the pubic bone, and not reaching higher than the 
navel. The consideration of the accidents of labor and 
the care of the infant will be treated in other chapters. 



CHAPTER X. 
ACCIDENTS AND EMERGENCIES OF LABOR. 

Women who have borne children before are apt to 
have rapid labors, hence a nurse should be on her guard 
when in attendance upon such a patient, watching for 
the symptoms of approaching labor, and notifying the 
physician earlier than she would feel warranted in doing 
with a patient expecting her first confinement. As soon 
as the nurse suspects that labor pains have begun, she 
should put her patient to bed. When " bearing-down " 
pains begin, the patient should not get up even to use 
the chamber. A bed-pan should be used. The patient 
should not be allowed, when the pains come on, to catch 
hold of anything to increase the force of her effort. 
Above all, the nurse should not tell her to bear down. 

The strength of the pains is somewhat modified if the 
patient is kept on her side. This position is also safer for 
the perineum, which does not so directly get the full 
force of a pain as when the patient lies on her back. 
The left side is preferable, as it enables the nurse to use 
her right hand to greater advantage. 

Should the child's head come down so that it can be 
seen at the entrance to the vagina, the nurse should place 

109 



I IO OBSTETRIC NURSING. 

herself on the right side of the bed, and as the patient 
lies on her left side, with the hips well drawn to the edge 
of the bed, the nurse should gently hold back the baby's 
head during a pain. This is to prevent a tear from oc- 
curring by the sudden expulsion of the head. She should 
favor the gradual stretching of the parts. She should 
avoid interfering in any way, as in making efforts to 
enlarge the opening by stretching it with the fingers, etc. 
All such attempts will inevitably result in harm. When 
the opening is sufficiently stretched, the head will slip 
out of itself. The passage of the child's head is ren- 
dered easier if the patient's knees are separated by a 
pillow. The nurse should simply continue to support 
the head with her hand, and as soon as the head is born 
her left hand should be placed over the mother's abdo- 
men, resting upon the womb, which may be distinctly 
felt through the abdominal walls. The pressure of the 
hand acts as a stimulant to the womb and induces good 
contractions. A tendency to hemorrhage is thus averted. 
The right hand of the nurse should support the child's 
head. With one finger she should/"^/ around the baby's 
neck to learn whether it is encircled by a loop of the navel- 
string or cord. If so, she should gently pull first on one 
side and then on the other, of the cord, to see which end 
gives. This loosens the pressure and prevents the stop- 
page of the circulation in both cord and child's neck. 

When, after a pause, the pains start up again to expel 
the rest of the child's body, the nurse had better have 
some one instructed how to hold the womb properly, as 



ACCIDENTS AND EMERGENCIES OF LABOR. I I I 

both her own hands will be needed to receive the body of 
the child as it is expelled. The mother herself may be 
shown how to make this pressure over the womb. If 
there is no one to make this compression of the womb, 
the nurse should try to manage the baby with one hand 
and keep up the pressure over the lower part of the 
abdomen with the other. The flannel wrap for the baby 
may be put close up to the mother's hips, and the nurse 
can manage with one hand to lay the baby down on this, 
cover it up, and draw it far enough away from the 
mother's hips to keep it out of the discharges. She 
should see that the baby's mouth is free from liquids. The 
little finger of her right hand acting as a hook, the end 
of the finger should be passed in at one corner of the 
baby's mouth and out at the other corner, thus scooping 
out any liquids that may have been drawn in during the 
birth. She should be careful to see that the cord is not 
dragged upon and that the baby breathes well. Babies 
usually cry lustily just after the birth. This should be 
a welcome sound to both nurse and mother, as it ensures 
expansion of the lungs. Occasionally, a child will be 
born with what is known as a "veil" or "caul" a por- 
tion of the membranes, drawn tightly over the face. 
This may cause death from suffocation unless it is 
quickly seized by the fingers and torn off, so as to free 
the child's mouth and nose. 

Resuscitation of Baby. — If the baby is apparently 
lifeless when born, besides the measures spoken of for 
clearing its mouth of liquids, it may be turned over on 



112 



OBSTETRIC NURSING. 



its face, to empty out the discharges from the air-pas- 
sages, and efforts should be made to start breathing. 
The head of the child should be lowered, to keep as much 
blood there as possible. 

The back may be slapped — several short, quick slaps 




Fig. 14. — Sylvester's Method of Resuscitation (First Movement). 



given over the buttocks. A stream of cold water may 
be poured on the chest just for a moment, and this 
repeated several times. 

If these fail, the nurse may breathe into the baby's mouth. 
To do this properly, the baby's nose should be held, the 



ACCIDENTS AND EMERGENCIES OF LABOR. 



113 



nurse's lips placed closely over the baby's open mouth, 
as she breathes into it, then the nurse's mouth is removed 
and the grasp on the nose loosened, the sides of the 
child's chest being pressed upon to press out the air. The 
number of breaths given by the nurse in a minute should 
not at first exceed twelve. 





1 

W - 



Fig. 15. — Sylvester's Method of Resuscitation (Second Movement). 



Sylvester Method. — Another valuable method of car- 
rying on artificial respiration is known as Sylvester's 
method. The baby is placed on its back, with a roll 
made by a towel placed under its shoulders. The head 

is thrown back. The arms are then slowly lifted and 

8 



114 OBSTETRIC NURSING. 

carried well up over the head. They are held in this 
position until five can be slowly counted. By this move- 
ment the ribs are elevated, the chest expanded, and a 
vacuum produced in the lungs into which the air rushes ; 
or, in other words, the movement produces " inspira- 
tion." The arms are then carried slowly downward, 
placed by the side, and pressed inward against the chest. 
This forces out the air and produces "expiration." These 
movements should be slow, repeated about fifteen times 
during each minute, and should be carried on until the 
breathing becomes regular. Should there be no sign of 
life, the efforts at resuscitation should not be abandoned 
for at least two hours after the birth. 

Schultze's Method.— A third method, which, how- 
ever, requires the separation of the baby from the after- 
birth, is most excellent. It is known as Schultze's 
method. It would be more apt to be practised by a 
physician, because it necessitates the early and quick 
tying of the cord and is only of advantage when prac- 
tised at once after the delivery. The method is as fol- 
lows : The child is seized by the shoulders and upper 
arms and swung head downward above the operator's 
head. The weight of the lower part of the body is thus 
thrown upon the chest, and any liquids which may have 
been drawn into the air-passages are thus forced out. 
Being held thus for a time, while the operator counts 
five, the body is then brought down in reversed position 
between the operator's knees. The weight of the lower 
extremities is thus made to drag upon the chest and 






ACCIDENTS AND EMERGENCIES OF LABOR. I 1 5 




Fig. 16.— Schultze's Method of Resuscitation (First Movement) 



n6 



OBSTETRIC NURSING. 



enlarge its capacity for the entrance of air. These two 
movements may be kept up for considerable time.* 




Fig. 17. — Schultze's Method of Resuscitation (Second Movement). 



* The order of these movements as given by Schultze is reversed. The 
upward movement is practised first in the Woman's Hospital, as it is found 
that the air-passages are thus best cleared of mucus and discharges before 
an act of inspiration is encouraged. 



ACCIDENTS AND EMERGENCIES OF LABOR. 



117 



Alternating with artificial respiration, warm baths may 
be employed from time to time. The temperature of the 
bath should be ioo° Fahr. After breathing is estab- 




Fig. 18. Fig. 19. 

Prochownick's Method of Resuscitation. 

lished, the child should be placed in warm wraps, with 
bottles of hot water around it. 

Method of Prochownick, of Hamburg. — A method 
of resuscitation more recently described (Centralblatt fur 



Il8 OBSTETRIC NURSING. 

Gynakologie, March, 1894) has been employed with great 
success for fourteen years by Prochownick, of Hamburg, 
in the severer grades of fetal asphyxia. As soon as 
delivered, the child is seized by its feet, as shown in 
Fig. 18 ; the child's forehead is allowed to rest lightly on 
a table or some other surface, the face being extended, 
so that the chin is thrown well forward and the trachea, 
or windpipe, freed from all compression. The mouth in 
this position hangs open. While an assistant holds the 
child in this position, the operator grasps the chest with 
both hands (see Fig. 18), and makes compression over it, 
thus imitating the act of expiration, by which discharges 
drawn into the air-passages may be expelled. A relax- 
ation of this compression permits expansion of the chest, 
and thus inspiration is effected. These movements are 
carried on rhythmically until natural breathing is estab- 
lished. When an assistant cannot be had the maneuver 
can be carried on as shown in Fig. 19, by means of one 
hand, although less efficiently. 

Laborde's Method. — Still another new method of re- 
suscitating an infant has been employed of late in France. 
The tip of the tongue being seized by means of a towel 
and held between the fingers, or held by means of the 
ordinary tongue forceps, the organ is drawn well forward 
and then pushed backward. Rhythmical movements of 
the tongue are thus kept up until respiration is estab- 
lished. 

Tying of the Cord. — If all is well with the child, 
it is best not to tie the cord until all pulsation ceases in 



ACCIDENTS AND EMERGENCIES OF LABOR. I 1 9 

it. This measure is thought to save the child some loss 
of blood. As the pulsation may last for an hour or 
more after the delivery, the afterbirth is generally ex- 
pelled before the cord is tied. To tie the cord, two 
pieces of bobbin, each eight inches long, dipped in a 
bichlorid solution (1-4000) or in some other antiseptic 
solution, should be used. The first ligature should be 
placed three inches from the child's abdomen. The 
string should be carried underneath the cord. In 
making the first tie, two twists instead of one should be 
taken to keep it from slipping. If the thumbs are 
placed upon the string in tying, the ligature can be 
drawn more tightly, and the grasp of the ends of the 
bobbin is more secure. The second knot is tied the 
same way. The ends may then be looped, making a 
bow-knot. The cord should be stripped, that is, the 
blood remaining in the vessels squeezed out toward the 
afterbirth, before each ligature is thrown around it. The 
second ligature is one inch further away from the inser- 
tion of the cord into the child's abdomen. After this 
second ligature is tightened, hold the cord with the fore- 
finger and middle finger at the ligature nearest the 
child, the thumb and other fingers at the other ligature, 
and cut it with a pair of dull scissors between these 
points. The extremities of the scissors are thus made to 
look toward the palm of the hand, and a sudden move- 
ment on the part of the child does not result in the same 
danger to it as there would be were the points not thus 
protected. After the cord is cut, squeeze the remaining 



120 OBSTETRIC NURSING. 

blood out from the end next the child. The scissors for 
this purpose are preferably dull, as the more ragged 
wound thus produced favors the closure of the blood- 
vessels. This lesson may be learned from nature, the 
lower animals gnawing off the cord after giving birth to 
their young, and thus no doubt decreasing the danger of 
bleeding. 

Position for Delivery of Afterbirth. — The best 
position for the mother during the delivery of the after- 
birth is on her back, hence she may be turned after the 
nurse has satisfied herself that the baby is in good con- 
dition. 

Twins. — Very occasionally, on placing her hand over 
the abdomen, after the delivery of the child, the nurse 
may feel another child there. In this case she must 
simply keep the womb well contracted by rubbing it 
gently through the abdominal walls, and wait for na- 
ture to go on with the work of expulsion. This baby 
must be cared for as the other. 

The afterbirth generally comes away within twenty 
minutes after the child's birth. Two or three pains 
occur, during which the nurse should keep the womb 
in the middle line of the abdomen and make gentle 
pressure backward and downward. With her right 
hand she should seize the afterbirth and membranes and 
twist them around several times to make a cord of the 
membranes, so that they may not tear, but all be ex- 
pelled at once. A discharge of blood and some clots 
generally follows the delivery of the afterbirth. The 



ACCIDENTS AND EMERGENCIES OF LABOR. 121 

nurse's left hand should still be kept carefully over the 
womb, which should feel hard and firm and should not 
reach above the navel. If it does not feel firm, rubbing 
over the lower part of the abdomen should again be re- 
sorted to until the round, hard body is felt. 

If the afterbirth does not come for an hour, and the 
physician has not yet come, send for another doctor. 

After the afterbirth has come, it should be put in a 
clean vessel, and, if detached from the baby, put in an 
adjoining room for the doctor to examine when he 
comes. Insist upon his seeing it, to find out whether 
it is all there. Have the baby removed to its crib and 
placed on its right side and properly covered. 

After-care. — Watch the womb carefully until the 
doctor comes. If it be firmly contracted, and no more 
blood be flowing from the vagina, place some dry nap- 
kins or a clean sheet under the patient, and wash off 
the thighs and surrounding parts with warm water con- 
taining bichlorid in the strength of 1-4000, and dry 
with a soft cloth. 

Slip the soiled clothing from under the patient, and 
then apply the binder and dressings, and make her 
comfortable. 

As soon as the doctor comes, report to him the exact 
time when the waters broke, when the baby was born, 
and when the afterbirth came. It is always best for a 
nurse to keep a written report with a statement of what 
she did. She should not, however, neglect her patient 
for the purpose of perfecting her report. 



122 OBSTETRIC NURSING. 

Breech Delivery. — Sometimes a nurse has the mis- 
fortune to be the only attendant at a breech delivery, 
that is, instead of the child's head coming first, the 
breech passes out from the birth-canal. Delivery in 
this manner is very dangerous to the life of the child. 
The nurse should do absolutely nothing here, as she 
would only make matters worse in trying to assist. 
These deliveries are long enough, as a rule, to give 
ample time for the summoning of some doctor to take 
charge of the case. In all breech cases the child is apt 
to need to be resuscitated, if it is alive at all ; hence 
plenty of warm water, etc., should be ready for the 
bath. 

Hemorrhage. — Flooding from the womb, or " uterine 
hemorrhage," is apt to occur either within the first 
twenty-four to forty-eight hours after the birth, when it 
is called "primary hemorrhage ; " or, it may occur some 
days after, when it is " secondary hemorrhage." The 
appearance of blood, either a constant oozing or a sud- 
den gush from the vagina, is, of course, the earliest 
symptom. 

A pulse of over ioo in a patient freshly confined 
should make the nurse exceedingly watchful in this 
respect, as it betokens a liability to hemorrhage. Should 
the flow continue, the patient becomes pale, faint, rest- 
less, gasps for breath, and finally dies unless the hemor- 
rhage is checked. A nurse should, of course, have the 
physician sent for at once, although he may have just 
left the house, or another doctor should be summoned. 



ACCIDENTS AND EMERGENCIES OF LABOR. 



123 



In the meantime, her first thought should be of the 
uterus and its probable condition of relaxation. The 
bandage, if applied, should be hastily removed, and the 
hand placed over the lower part of the abdomen. If the 
womb is not felt, rub vigorously until it contracts and is 
felt again as a round, hard body. Keep on rubbing and 
holding. The nurse should never take her hand off the 




Fig. 20. — Position of Patient in Hemorrhage after Labor. 



abdomen until the doctor comes. Direct some one else 
to take the pillows from under the patient's head, have 
the foot of the bed elevated, to keep the blood in the 
head and prevent fainting, which induces heart-clot. 
Have the foot of the bed placed on the seats of chairs. 
The patient may be fanned, cold water given her to 
drink, hartshorn to smell. She should not be allowed 
even to turn in bed or lift her head. If the doctor has 



124 OBSTETRIC NURSING. 

left ergot, one teaspoonful of the fluid extract may be 
given in a tablespoonful of water. The patient should 
receive this without lifting her head. Plenty of hot 
water should be on hand, the water in the tea-kettle 
boiling. If the physician delays his coming and the flow 
continues, repeated hot-water injections of about 1 1 5°— 
120° should be given into the vagina. 

Convulsions may come on during the labor as during 
the pregnancy. Their management would be the same 
as that suggested for convulsions during pregnancy. 

Other accidents, such as rupture of the uterus , or the 
coming down of an arm or hand, or the navel-string in 
advance of the usual part to come first, are conditions in 
which the nurse can do nothing, except to keep the 
patient as quiet as she can, and meddle as little as possi- 
ble until the doctor comes, for whom, of course, she 
must at once send. 

Deportment. — At no time, in the management of a 
case, should a nurse express surprise or consternation, 
nor should her manner indicate that she has such feel- 
ings. Like a true soldier, she must bravely and quietly 
face the most critical situations and meet their demands. 
She should by her manner give the mother to feel that 
all life's vicissitudes are best met by a quiet self-control. 

Fortunately, deaths during delivery in this enlightened 
age are few ; for the methods of averting accidents at 
such times have been so thoroughly studied, that acci- 
dents themselves are very rare. 

Obstetric Operations. — As operative procedures 



ACCIDENTS AND EMERGENCIES OF LABOR. 1 25 

during the course of a delivery may have to be resorted 
to very suddenly and unexpectedly, a nurse should have 
things in readiness should the emergency arise. The 
especial preparations necessary will consist in the making 
of a cone of stiff paper, into which a towel is fitted, for 
the purpose of giving the patient ether; arrangements 
for an abundant supply of hot water, to be had at a mo- 
ment's notice ; facilities for making up antiseptic solu- 
tions quickly; a small pitcher containing a warm two 
per cent, creolin solution for the physician's instruments ; 
some kind of grease, as carbolized cosmolin, for lubri- 
cating these instruments when desired ; English rubber 
catheter and urinal conveniently at hand ; a basin with 
a two per cent, carbolic solution for needles, sutures, 
and scissors ; absorbent cotton in small pads, or soft 
linen rags dipped in an antiseptic solution, to be used 
instead of sponges ; sufficient protection for the floor at 
the side of the bed ; and preparations for resuscitation 
of the infant. 

The position of the patient for most obstetric opera- 
tions will be across the bed, with her hips well over the 
edge. This is called a " cross-bed!' Physicians gener- 
ally call simply for a cross-bed, in desiring the nurse to 
make preparations for an operation, and she should 
understand that this refers to the arrangement of pro- 
tectees and sheets, adjustment of pillow, and placing of 
patient in proper position. Should there not be a suffi- 
cient number of persons to have one hold each leg, 
chairs should be placed in such a way at the side of the 



126 OBSTETRIC NURSING. 

bed as to support the widely separated feet. A chair 
for the physician should be placed between these, facing 
the bed. As there is usually some assistant to give the 
ether, the nurse will need no help in keeping the limbs 
apart and in giving the physician any other aid she can 
in the supply of the various articles as they are needed. 
Should the physician desire her to give the ether, her 
whole attention should be devoted to administering the 
anesthetic and seeing that the patient keeps in good con- 
dition. Strict watch should be kept over the respira- 
tions and the pulse. Difficult breathing, or a stoppage 
in the respirations, weakness or irregularity of the pulse, 
blueness of the face and lips, should at once be called 
to the physician's notice, the ether cone being removed 
from the patient's face. After the patient is once well 
under ether, it takes but little to keep up the anesthesia, 
so that the nurse should use the ether sparingly ; a few 
drops every few minutes upon the towel are, as a rule, 
sufficient. After etherization the patient may vomit, and 
there will be greater tendency to bleeding because of 
the relaxation induced by the anesthesia, hence the nurse 
should exercise special watchfulness and care over the 
patient. The vomiting is often relieved by a mustard 
paste over the stomach, while the bleeding may be con- 
trolled by the hand placed over the lower part of the 
abdomen, which, by making pressure over the womb, 
insures good contractions. After the nausea is relieved, 
ergot, if prescribed by the physician, may be given. 



CHAPTER XI. 
MANAGEMENT OF THE LYING-IN. 

Immediately after the delivery it is necessary that the 
patient should have rest. The room should be kept ex- 
ceedingly quiet and the shades drawn down so as to sub- 
due the light. 

The patient may be allowed to sleep, but the nurse, 
during this time, should watch her very carefully, as 
there is a liability to bleeding when the sleep is too deep, 
owing to the general relaxation induced by sleep. She 
should draw the bedclothes up at one side from time to 
time, to see how r much blood is lost. 

There should be no unpleasant smell about a confine- 
ment room, plenty of fresh air should be allowed to 
enter, and all discharges should be at once removed 
from the room. 

While the patient sleeps, and after the child has re- 
ceived proper attention, the nurse should place the 
soiled sheets, tozvels, and all articles stained with blood in 
cold water to soak. 

The afterbirth, also, should be disposed of. If in the 
country, it should be buried in a hole dug" in the yard, 
two or more feet deep. It should never be thrown 

127 



128 OBSTETRIC NURSING. 

down a water-closet or privy. In the city it is best to 
burn it at night. It may be put in the range or stove 
and well covered up with coals. Clots of blood may 
safely go down the water-closet, as they readily dissolve. 

To return to the soiled clothing left after a confinement 
— though a trained nurse will not often be called upon 
to attend to the washing of these articles, there will be 
times when it would be better that she should do so, 
both to save the patient expense and trouble and to 
prevent their lying about too long. At any rate, she 
should know how it should be done. Should the cloth- 
ing be put to soak before the blood has dried into it, 
and allowed to remain for a few hours, the water being 
changed as often as needed, the washing will not be 
difficult. 

As a rule, it is not best that a nurse should leave her 
patient or the baby long enough to attend to this wash, 
hence it is advisable to have it put out or done by some 
one else in the house. The soaking ought, however, 
always to be attended to by the nurse, because it facili- 
tates the subsequent washing. 

In the after-care of the patient the nurse should attend 
to the washing of the mother s and babys napkins. She 
should, if needed, wash the baby's flannels and slips. 

Visitors. — For a week a newly-confined patient should 
see no visitors. Even the husband should not remain 
in the room long at a time. No painful or exciting news 
should be communicated to the patient, as a distressing 
form of mental trouble to which lying-in women are 



MANAGEMENT OF THE LYING-IN. 1 29 

prone may be thus induced. This is known as " puer- 
peral mania." 

Food. — After the patient rouses from her first sleep 
she is generally hungry. The nurse should have learned 
from the physician before he left what he would prefer 
her having. A cup of warm milk or tea — not too hot — 
may be given directly after the confinement when ether 
has not been taken, and this followed in three or four 
hours by a light meal, as toast and tea or gruel. With 
regard to the diet of the lying-in, nurses must be pre- 
pared to follow the rules of the physicians for whom 
they work. Some physicians allow considerable variety 
in the food from the beginning. 

The following directions concerning the diet are given 
to the nurses of the Woman's Hospital : " It should be 
remembered, in the diet of the lying-in woman, that the 
amount of liquids, should the breasts or nipples threaten 
to give trouble, must be limited, not only until after the 
secretion of milk, but also until the supply of milk adapts 
itself to the demand, for the first five or six days after 
the confinement. 

As soon as the patient is made comfortable after the 
birth, she should have a cup of warm milk or weak tea, 
or warm water and milk. 
First meal-time : Plate of milk toast or bowl of oatmeal 

gruel, or saucer of wheat germ or boiled rice. 
Second meal : Cup of weak tea or warm milk, dry toast, 

or milk toast, or water toast, or soda crackers soaked 

in hot milk. 
9 



I3O OBSTETRIC NURSING. 

Third meal : Saucer of oatmeal mush or wheaten grits, 

with a cup of tea or warm milk, with Graham biscuit 

or dry toast. 
Forenoon, afternoon, bedtime : Lunch, a cup of warm 

milk, with a piece of dried bread or Zwieback. 
Second Day. — The same as above. 
Third Day. — The same, with the addition of stewed 

apples or baked apples for supper. 
Fourth Day. — Breakfast : Soft-boiled egg, dried bread, 

stewed fruit, and cup of milk or weak tea. 
Dinner : Plain beef or mutton-broth, dried bread, and 

farina or junket. 
Supper : Baked apples or stewed prunes, saucer of wheat 

germ, and Zwieback. 
Fifth Day. — Breakfast : Cup of weak coffee or cocoa, 

mutton-chop, oatmeal mush, dried bread, and a sweet 

orange or ripe apple. 
Dinner : Beef or mutton-broth or oyster-stew, baked 

potato, stewed tomatoes, dried bread, farina, junket, or 

rice. 
Supper : Stewed fruit, Indian-meal mush, and Zwieback. 
Sixth Day. — Ordinary plain diet, avoiding salads, sour 

fruit, fried or highly-seasoned meats, fancy desserts, or 

sweets of any kind. 

This holds good of all subsequent meals. The above 
dietary will require to be modified when special indica- 
tions arise. Should the patient's temperature rise to ioo° 
Fahr., or above, she should be kept on liquid diet, as 
milk and beef-tea alternately every two hours. 



MANAGEMENT OF THE LYING-IN. I3I 

As liquids favor the secretion of milk, liquid food 
should constitute a large proportion of the nourishment 
taken by nursing women throughout the lying-in, pro- 
vided there is not a tendency to over-secretion. The diet 
should be plentiful and nutritious, but selected carefully 
with reference to its digestibility. As the patient must 
remain inactive for some time, it will not do for her to 
eat the starchy vegetables, pastry, or warm breads, for 
all these require very active powers of digestion. 

A nurse should thoroughly understand the art of 
cooking, and be able to provide her patient with palatable 
and nutritious dishes, daintily and prettily served on a 
tray, until, with the physician's consent, she takes her 
place at the family table. Even then a nursing woman 
will need to receive some nourishment, as gruel, beef-tea, 
milk, etc., between the regular meals, for she must not 
only provide for herself, but her child. 

Duration of Lying-in. — The lying-in lasts six weeks. 
During this time the organs of generation are returning 
so far as possible to their former condition. It is im- 
portant that the patient should have rest, and for at 
least two weeks of this time should be in bed. 

Involution. — The process of changes by which the 
womb shrinks to its normal size is known as " involu- 
tion!' This process is favored by the patient lying as 
much as possible on her back, so that the womb does 
not incline too much to one side or the other. The 
patient may be carefully propped up a little by pillows 
on the third or fourth day, so that she shall be in a 



132 OBSTETRIC NURSING. 

semi-reclining position. This facilitates the drainage of 
the uterus. Care must be taken not to permit her to 
move herself too much, as a hemorrhage may be thus 
started. The progress of involution is determined by 
the height of the , uterus as appreciated by palpation 
over the lower part of the abdomen. Under the most 
favorable conditions the uterine fundus will be found to 
correspond in height with the following points : — 

Twenty-four hours after labor, — on a level with the 
umbilicus. 

Second and third day, — midway between umbilicus 
and symphysis pubis. 

Fifth and sixth day, — three fingers' breadth above the 
pubic symphysis. 

Ninth and tenth day, — on a level with the pubic 
symphysis. 

A full bladder or a full rectum will prevent proper 
contraction and decrease in size of the uterus, as also 
will subinvolution from former uterine disease of any 
kind, or from inefficiency of the uterine muscular tissue. 

The Lochia. — The discharges of the mother con- 
tinue about two weeks, and they are called the "lochia." 
For the first twenty-four hours they are blood ; the 
second and third day, watery blood ; from the fourth to 
the sixth day they have a greenish-yellow coloration, 
and from the tenth to the twelfth day they become 
white. This white discharge may continue for a long 
time after the confinement. The character of the dis- 
charge will indicate the process of involution, hence the 



MANAGEMENT OF THE LYING-IN. 1 33 

physician should see daily the napkins or dressings re- 
moved from the patient. Soiled napkins and dressings 
should never be kept in the patient's room, but in some 
closed vessel, as a clean chamber or a slop jar, with a 
close-fitting lid, in another room. The existence of the 
least odor about the discharge should at once be 
brought to the physician's attention. If napkins are 
used, they will need to be changed during the first day 
about every two hours, sometimes oftener, the second 
and third day about every three hours, the fourth and 
fifth day every four hours, until, by the tenth day, about 
three changes are sufficient. The antiseptic dressings 
are changed, as a rule, every three hours until the dis- 
charge ceases. If it be very scant, a change once in 
six hours may be sufficient. These antiseptic dressings 
should be burned. The napkins should be soaked in 
cold water until the blood is well out of them, and then 
thoroughly washed and boiled. The boiling is suffi- 
cient, if properly done, to render them aseptic, but, as 
an additional precaution, they may be wrung out in a 
1-2000 bichlorid solution before drying. The patient 
should be washed off each time the napkin is changed with 
a warm antiseptic solution, as 1-4000 of the bichlorid 
of mercury. Care should be taken not to irritate the 
parts. Instead of using a soft cloth to wash off the 
parts, the water may be poured in a small stream over 
them, and a soft, dry cloth pressed gently over them to 
remove all moisture. Especial care should be taken 
where there are stitches not to pull them in any way. 



134 OBSTETRIC NURSING. 

Bathing. — One daily washing of the entire body is, 
as a rule, desirable. The doctor's advice, however, 
should be asked concerning the matter. This wash, 
when given as a sponge-bath, need not exhaust the 
patient, nor cause too much movement of her body. 
The patient should never feel chilly during this bath; 
should she do so, the bath must at once be stopped. 
The bath should, of course, be given under cover. The 
increased activity of the skin necessitates especial clean- 
liness, and the daily bath is found, when properly given, 
to be very refreshing. Frequent changes of bed and 
body clothing, too, are necessary — the body clothing, if 
possible, daily until the discharges cease. 

Attention to Bladder. — The bladder is frequently 
paralyzed after confinement, as a result of the pressure 
to which it has been subjected during the birth. When 
it is filled beyond a certain limit, it may respond to the 
irritation and a little urine be voided, but the bladder 
not be emptied. The nurse can tell by the amount 
passed whether the patient has probably emptied the 
bladder or not. The secretion of urine early in the 
lying-in is very free, hence the quantity passed should 
never be scant. By placing the hand over the lower 
part of the abdomen, the bladder may be felt as a soft 
tumor on one or the other side, above the pubic bone, 
the womb being felt as a harder mass pushed to the 
opposite side. 

The catheter should not be used without the physi- 
cian's sanction, but a nurse should never forget to ask 



MANAGEMENT OF THE LYING-IN. 1 35 

very particularly about this matter before he leaves the 
house after the delivery. It is generally undesirable to 
allow a patient to go longer than six hours without 
freely emptying the bladder. As over-distention of the 
bladder prevents proper contractions of the womb, and 
as a relaxed womb is a frequent cause of after-pains, it 
is best to have the bladder quite frequently emptied 
during the first twenty-four hours. Hence, if the 
catheter is permitted to be employed, it may be well to 
use it about three hours after delivery for the first time 
(the physician having used it, if necessary, immediately 
after delivery). Its subsequent use should be limited to 
about once in six hours, unless its more frequent use is 
demanded by the interference with the contractions of 
the womb caused by over-distention of the bladder. 
The patient should be encouraged to make a trial to 
urinate as soon as possible, so that the use of the cathe- 
ter may be entirely dispensed with. Great care is 
necessary in the use of the catheter : ist, to see that the 
instrument is thoroughly clean and kept clean ; 2d, to 
see that none of the vaginal discharges are carried into 
the bladder during its introduction; 3d, to do no injury 
to the mother's parts or give her needless pain. 

The instrument, or silver catheter, should be thoroughly 
boiled if there is any doubt about its being aseptic. 
When withdrawing it the outer extremity should be kept 
lowered, so that all the urine remaining may flow out 
from it, and no sediment settle in the closed end to be- 
come a source of contamination at some future time. 



I36 OBSTETRIC NURSING. 

It should then be thoroughly washed in hot water, 
which should be allowed to flow through it from the 
inner toward the outer extremity, carrying out any sedi- 
ment from the urine, and it may be kept during the 
intervals of its use in an antiseptic solution — a two per 
cent, solution of creolin or carbolic acid. To prevent 
the carrying of the vaginal discharges into the urethra 
the parts should be carefully washed off with an antisep- 
tic solution, either by irrigation or by means of a soft 
cloth, before the insertion of the catheter. 

The index finger of the nurse's right hand (which 
should each time be thoroughly cleansed in an antiseptic 
solution) should be slipped into the vagina as far as the 
second joint, and made to follow the anterior vaginal 
wall down in the median line to the vaginal entrance, 
when a little elevation of the surface will be felt, 
immediately above which the orifice of the urethra 
is to be found. If the finger be held with its palmar 
surface upward and resting lightly upon this elevation, 
the finger being held horizontally, a catheter * slipped 
along it will enter the small orifice of the urethra. 
Should the extremity of the catheter seem to meet 
with any obstruction after its entrance into the ure- 
thra, a slight withdrawal and rotation of the instru- 
ment will generally carry it in. The use of the 
catheter need not involve the slightest exposure of 
the patient. A cultivated touch will enable a nurse to 

* Glass catheter. 



MANAGEMENT OF THE LYING-IN. 1 37 

do better than by sight in its use. Hence, it may all be 
done under cover. 

Difficult Micturition. — For the first twenty-four to 
forty-eight hours after delivery, particularly if the labor 
has been a difficult one, there is a considerable swelling 
of the parts, which offers a mechanical hindrance both 
to voluntary urination and the passage of the catheter. 
Great gentleness is therefore required in the necessary 
manipulations. This swelling in an ordinary case should 
disappear at the end of twenty-four to forty-eight hours. 
Should the inability to urinate persist after this, it is in 
all probability due to the condition of paralysis before 
referred to. Especial medication by the physician, as 
the use of muscle and nerve tonics, fomentation over the 
lower part of the abdomen and external generative 
organs, hot water in a bed-pan, placed beneath the 
patient's hips, may serve to stimulate voluntary urina- 
tion. The attempt to induce this should be made each 
time before a resort to the catheter, as the constant use 
of the latter will only keep up the difficulty. 

Constipation. — As a rule, there is no movement of 
the bowels for the first three days, constipation being 
due to paralysis of the bowels caused by the pressure of 
the gravid womb upon the bowels. Regulation of the 
food will do much to correct this habit, as a laxative diet 
composed mainly of brown bread, oatmeal gruel, prunes, 
etc. An occasional enema of warm soapsuds may be 
needed, or from a teaspoonful to a tablespoonful of 
glycerin may be injected into the lower bowel, or a 



I38 OBSTETRIC NURSING. 

glycerin or gluten suppository be given. If these means 
do not suffice, some medication may be needed. The 
laxative chosen by the physician will depend upon the 
condition of the breasts, as well as its liability to affect 
the milk. 

Should the breasts be over-distended, a saline laxative 
will be preferred. Thus, two teaspoonfuls of Rochelle 
salts in a half-tumberful of cold water may be given, an 
additional tumblerful of pure water being taken after it. 
Sulphate of magnesia or Epsom salts may be used in 
the same way, or a teaspoonful of cream of tartar may 
be taken night and morning in a cup of sweetened 
water. 

When the secretion of milk is scanty, a vegetable lax- 
ative is to be preferred, as rhubarb, aloes, or cascara 
sagrada. 

At times there is such impaction of the contents of 
the lower bowel that an oil injection will be needed. A 
gill of cotton-seed oil may be introduced into the lower 
bowel and retained for three or four hours, after which 
a small soap and water injection will lead to a thorough 
evacuation of the bowel. 

The Care of the Nipples and Breasts is very im- 
portant. If this matter has received proper attention 
during the pregnancy, there will be comparatively little 
trouble during the lying-in. It is important to keep the 
nipples clean. Milk should not be allowed to collect 
about them, hence immediately after nursing, while they 
are swollen and soft, they should be washed ; a soft 



MANAGEMENT OF THE LYING-IN. 1 39 

piece of linen may be used and cold water, or a saturated 
solution of boric acid, after which they may be dried 
with a soft cloth. This should be repeated after every 
nursing. 

If the skin of the nipple be unusually thin, it is best to 
avoid having the baby pull directly upon the nipple until 
the milk flows freely, hence a nipple shield should be 
used, at least for the first two or three days, if not 
longer. 

Should the nipple become sore at any time, the nipple 
shield should again be resorted to and used until the 
sore is healed. 

Some application, as a ten per cent, solution of tannic 
acid in tincture of myrrh, balsam of Peru, or a weak 
solution of nitrate of silver, according to the order of the 
physician, may be painted with a camel's-hair brush over 
the cracks in the nipple while it is soft and swollen, im- 
mediately after nursing. A very healing application 
consists of a paste made of equal parts of bismuth sub- 
nitrate and castor oil. This can be kept constantly 
applied in the intervals of nursing. This may be wiped 
off when the time for nursing arrives, but need not be 
entirely removed, as it cannot hurt the baby. This paste 
or the application of a little oil or cold cream to tender 
nipples will often prevent their cracking. 

For afty nipple shield to work perfectly it must fit 
tightly, hence an entire rubber shield is not so good as 
some others. Some shields are made of part metal and 
part rubber, others part rubber and part glass. The 



140 



OBSTETRIC NURSING. 



cheapest are the ordinary glass shields with rubber 
nipples. They cost about fifteen cents and are quite as 
good as those that are higher priced. 

A shield is not good if it allows the nipple to be drawn 
out too far. In the intervals of nursing the rubber 
nipple should be kept in cold water after having been 
turned inside out and thoroughly cleaned with a brush. 
Nipple protectors are worn only in the intervals of nurs- 
ing, or during pregnancy, for shaping the nipple.* These 

may be made of lead, glass, or 
wood. Leaden protectors keep 
the nipples soft in the intervals 
of nursing, and have a healing 
effect upon the abrasions and 
cracks of a tender nipple. Un- 
less care be taken, however, to 
cleanse the nipple thoroughly 
before the baby nurses, there is 
danger of lead-poisoning. Nip- 
ple protectors of glass and wood, 
being open at the top, are intended more to keep the 
clothing of the patient off the tender nipple. f The nip- 
ple may, in addition, be kept moist in the intervals of 
nursing by the application over it of a piece of absor- 




Fig. 21. — Nipple Shield. 



* See Fig. 6, page 42. 

f There is a form of nipple protector made of glass which also acts as 
a reservoir to catch the overflow of milk in cases where it flows involun- 
tarily from the nipple. This is very nice in preventing the constant wetting 
of the patient's clothing. 



MANAGEMENT OF THE LYING-IN. I4I 

bent cotton saturated with a mixture of one part gly- 
cerin to two parts water. The oily preparations are to 
be preferred. 

Shape of Nipples. — Nipples vary much in shape — 
thus they may be cone-shaped, hollow, mushroom- 
shaped, and depressed. 

The cone-shaped nipple is the best, as it can be readily 
seized by the child's mouth, and the pressure of the 





Cone-shaped. Hollow. 




Mushroom-shaped. Depressed. 

Fig. 22. 

baby lips does not constrict the nipple at its base, so as 
to prevent the free escape of milk from the mouths of 
the milk ducts which open at the top of. the nipple. The 
mushroom-shaped nipple has so narrow a base that the 
free flow of milk may be thus prevented. 

The hollow nipple is apt to get sore from two causes ; 
first, by the forcible suction made by the child in empty- 
ing the breast; second, by the accumulation of milk in 
the depressed portion of the apex. 



142 



OBSTETRIC NURSING. 



The depressed nipple differs from the last class in the 
fact that there is no elevation of the nipple above the 
surface of the breast, but where the nipple should be 
there is a corresponding depression. Very little may be 
done for such a nipple, and all efforts to make a nipple 




Fig. 23. — Figure-of-eight of One Breast. 



by drawing it out must generally be abandoned, as they 
simply irritate the tender skin. 

Bandaging of Breasts. — It is best when nipples of 
this class exist to abandon the idea of nursing the child, 
and prevent the accumulation of milk in the breasts by 
bandaging. This should also be done where there is a 



MANAGEMENT OF THE LYING-IN. 



143 



previous history of breast abscess — the breast affected 
being thus bandaged to prevent the attempt at secretion 
by the gland. 

The firmest bandage is the figure-of-eight of the breasts, 




Fig. 24. — Figure-of-eight of Both Breasts. 



which may be applied to one or both of the breasts 
according to need. If it cannot be used, the wide, 
straight bandage, similar to an abdominal bandage, may 
be employed, or the straight bandage with straps to 
fasten it over the shoulders, according to the pattern 



144 OBSTETRIC NURSING. 

used by Dr. Garrigues, of New York. Were the milk 
permitted to accumulate in the breast, and there be no 
ready outlet for it, " caked breast " would be apt to ensue. 
" Caked Breast" is caused by a collection of milk in 
one or the other part of the breast, due to blocking up 
of a milk-duct. The indications for its relief are to empty 
the breast. The milk may be drawn out by a baby if 
there be a proper nipple, or by the use of the breast- 
pump. 





Fig. 25. — Garrigues' Breast Bandages. 

The breast may be gently rubbed with warm oil and 
stroked from the base toward the nipple to aid in carrying 
the milk toward the mouths of the milk-ducts. Camphor 
liniment is sometimes used as an inunction, alone or 
combined with laudanum, but unless it is the intention 
to help to dry up the milk, camphor should be avoided. 

The use of fomentations before rubbing greatly helps 
to soften up the breast. By fomentations is meant the 
application of flannels wrung out in hot water, constantly 
changed as they cool. These applications should be 



MANAGEMENT OF THE LYING-IN, 



145 



continued for fifteen to twenty minutes at a time. After 
their use if the baby be put to the breast or the breast- 
pump be used, the milk will generally flow quite freely. 

Breast-Pumps. — Those breast-pumps are the best 
which depend for suction on the power of the mouth. 
The Phoenix breast-pump is the one generally preferred. 

They may be used by the nurse, or a patient may use 
such a pump herself should a nurse not be present. 
Hand-pumps are not good, as too much force is apt to 




Fig. 26.— Breast-Pump. 

be used in making suction — the nipple may thus be torn 
off. Where a breast-pump cannot be had, a simple con- 
trivance may be resorted to for emptying the breasts 
which is often very effective. A bottle filled with very hot 
water may be emptied of its contents, and while still hot 
the mouth of the bottle closely applied over the nipple. 
As the bottle cools the nipple is drawn up into the neck 
of the bottle, and the flow of milk induced. 

Pendulous Breasts, — When the breasts are pendu- 
10 



146 



OBSTETRIC NURSING. 



lous, handkerchief bandages, properly applied, make a 
good support. 

Their application is as follows : " The base of the 
handkerchief, folded as a triangle, should be placed 
obliquely across the chest and under one breast, with the 




1 « m 




Fig. 27. — Handkerchief Bandage for Breast. 



apex or summit of the triangle over the corresponding 
shoulder ; one angle is carried over the opposite shoulder, 
the other under the axilla, or armpit, of the same side. 
These ends should be tied on the back of the shoulder, 
and the apex of the triangle pinned to them." (Smith.) 






MANAGEMENT OF THE LYING-IN. 1 47 

Should both breasts need support, a similar bandage 
may be applied to the other breast. To prevent the 
base of one or both of these bandages from slipping up, 
the ordinary handkerchief bandage has been modified 
in the Woman's Hospital by the addition of a belt 
around the waist, of a strip of muslin or ordinary roller 
bandage, to which the base of the bandage may be fast- 
ened by safety-pins. 

A simple straight bandage, with a compress to lift the 
outer, pendulous portion of each breast, is sometimes 
used, darts being employed to shape it properly to the 
person. This makes a firmer support than the handker- 
chief bandage. It should be made of unbleached mus- 
lin or some firm material. 

Another bandage, which has the advantage of not re- 
quiring to be removed when the baby nurses, is the 
double-Y bandage, used in the Boston Lying-in Hospital. 
The manner of putting it on is thus described by Dr. 
Worcester : "A single T-bandage is first made by folding 
a napkin lengthwise so that for an average-sized patient 
it shall be 32 inches long by 3 inches wide. At the middle 
of this, and at right angles to it, is pinned, just between 
its folds, a napkin of the same size, similarly folded. 
This T-bandage is next made into a Y-bandage, by 
making a diagonal fold in the middle of the cross-piece 
and fastening the corners of the plait with safety-pins 
on the outside. The bandage is now ready to put on. 
The tail-piece is passed under the woman's back, snug 
up to her armpits, so that the fork of the Y just clears 



148 



OBSTETRIC NURSING. 



one nipple when that breast is held upward and inward 
on the chest. The tail-piece on the other side is carried 
up on the chest directly over the breast. The arms of 




Fig. 28. — Worcester's Y-Bandage. The upper figure shows the double Y-breast 
bandage in position ; the lower left-hand figure shows how the bandage is made. 
The third figure shows how the double Y-bandage is completed by fastening the 
arms of the Y to the tail-piece on the patient's opposite side. 



the Y are then brought over the chest, one above and 
the other below the breasts, and their ends pinned to 
the tail-piece, so as to hold both breasts in similar posi- 
tion. A compress of soft linen may be placed between 



MANAGEMENT OF THE LYING-IN. 



149 




Fig. 29. — Obstetrical Breast 
Support, with Knitted 
Bosoms. 



the bandage and the outside of the breasts, and also 
between the breasts, to prevent their chafing. To keep 
the bandage from slipping down straps of muslin may 
be passed over the shoulders and pinned back and front. 
To keep it from slipping up, it may 
be fastened to the abdominal ban- 
dage." The bandages referred to 
are very useful while the patient is in 
bed, but when she begins to sit up 
and wear ordinary clothing they will 
be found to be cumbersome. Some 
such breast support as is shown in 
Fig. 29 may then be found very use- 
ful. It may be obtained at the Dress Reform Empo- 
rium, in Philadelphia, and at similar agencies in other 
cities. 

Gathered Breasts. — There is nothing in the care of 
a lying-in patient for which a nurse receives more blame 
than in the occurrence of gathered breasts. Abscesses 
will sometimes come, however, in spite of all precau- 
tions, even before confinement. Extreme watchfulness 
and a prompt reporting of any symptoms of beginning 
trouble, as chilliness, hardness of the breasts, sore nip- 
ples, etc., will do much to avert them. It must never be 
forgotten that sore nipples, by offering an open surface 
upon the mother's body, may become avenues of septic 
infection. Dirty hands or dirty garments touching these 
surfaces or poison from the baby's mouth may thus 
enter the mother's system. One of the most serious 



I50 OBSTETRIC NURSING. 

forms of inflammation of the breast may thus result 
from blood-poisoning. If the breast has once gathered, 
there will be a tendency for it to gather again. Should 
an abscess threaten by beginning inflammation of the 
breast, the treatment will, of course, be directed by the 
physician. What milk is in the breast must be drawn 
out, and some means used to prevent further secretion. 
Belladonna breast plasters were at one time much used, 
the circular breast plasters being obtained at any drug 
store. The belladonna ointment spread on patent lint, 
shaped to the breast, is preferred by some physicians. 
Simple compression of the breast by a firm bandage is 
generally sufficient, without the aid of other measures, 
in the checking of the secretion. 

Should the breast gather, lancing is inevitable, and 
the sooner the better, so that a nurse should keep the 
physician carefully informed as to the condition of the 
breast. Flaxseed poultices or, far better, antiseptic 
poultices (consisting of several layers of sterilized gauze 
wrung out of hot sterile water and covered by gutta- 
percha tissue), may need to be applied for a time, both 
before and after lancing. These poultices, to do any 
good, should be applied as hot as possible. The nurse 
can test the heat of the poultice by laying her cheek 
against it. If she can bear this application -without find- 
ing it too hot, the patient will also probably be able to 
bear it. If the poultice be made on flannel it will not 
lose its heat as quickly as when made on muslin. The 
poultices will require changing about once in two hours, 



MANAGEMENT OF THE LYING-IN. 1 5 I 

or often enough to keep them warm ; and should be 
kept up until the abscesses point and are evacuated. 
The nurse should encourage the patient to have an 
abscess lanced, and should have prepared, at the time of 
the operation, the antiseptic solutions preferred for the 
physician's hands and for washing out the abscess cavity, 
a syringe, if possible, a pus-pan having a concave side to 
fit closely under the breast, some charpie (linen threads 
arranged in bundles for packing abscess cavities), soft 
towels, and some absorbent cotton to be used in place 
of sponges for cleansing the breast. Before the opera- 
tion, the breast should be washed off with an antiseptic 
solution. Between the applications of the different poul- 
tices the breast should be similarly washed off by the 
nurse. The physician will probably desire to wash out 
the abscess cavity daily so long as the discharge of pus 
continues, in which case the nurse should have every- 
thing in readiness at the time of his expected visit. 

Galactorrhea. — Sometimes milk runs constantly from 
the breasts. Much may be done to prevent this by 
regular nursing. If it persists, the amount of liquid in 
the food should be restricted. Sometimes the milk runs 
from the opposite breast while the baby is nursing at 
one. There is no way to prevent this. Some mothers 
collect it as it drops in a small bottle or cup and feed it 
to the baby. 

Insufficient Milk. — If the mother has only sufficient 
milk for half the day, the baby had better be artificially 
fed by day, the breast milk being reserved for the night, 



152 OBSTETRIC NURSING. 

as giving less trouble when the care of the child de- 
volves upon her. 

After-pains are the same as labor-pains, being caused 
by contractions of the womb. They are called after- 
pains because they occur after confinement. A woman, 
after the birth of her first baby, seldom has after-pains. 
They may occur with varying severity in women who 
have previously borne children. If the bladder and the 
bowels are properly attended to, and the womb kept well 
contracted, the patient is not likely to suffer much from 
after-pains. 

These pains seldom last over the second day. Should 
they do so, it is probable that the patient is threatened 
with some inflammation. 

The occurrence of after-pains should, of course, be at 
once reported to the doctor, and such measures for relief 
carried out as he may suggest. 

The womb will be found to be in two entirely different 
conditions with the occurrence of these pains. Hence, 
we divide the pains into two classes, the "expulsive" and 
the "spasmodic" or " neuralgic." 

With expulsive after-pains the womb, as it is felt 
through the abdominal walls, will be found to be large 
and soft, and the patient will often pass clots. The 
bladder will be frequently found to be over-full and the 
womb pushed high up or to one side. The indications 
are to empty the bladder and to secure good contractions 
of the womb. After the bladder is emptied the pain 
may be relieved by the application of a hot poultice over 



MANAGEMENT OF THE LYING-IN. 1 53 

the lower part of the abdomen, and simple fluid extract 
of ergot may be given, if desired by the physician {y 2 
teaspoonful every three hours), until the womb is well 
contracted. A nurse should never give any medicine 
without the direction of the physician. Before entire 
relief is obtained it may be necessary for the physician 
to break down and wash out the clots within the womb. 

Intra-uterine Injection. — The nurse should slip 
drawers and stockings on the patient in preparation for 
this operation, as she may need to lie across the bed 
with her hips drawn to its edge. A bed-pan, syringe, 
antiseptic solutions, receptacle for waste water, and 
rubber protective for bed and floor should be prepared. 

When spasmodic after-pains occur, the womb is felt in 
the lower part of the abdomen as a firm, round ball of 
stony hardness. This is caused by a spasm of the mus- 
cle fibers in the womb. The remedies which would help 
expulsive pains would only aggravate this condition. 
Something must be employed which will quickly relax 
the spasm. The most efficient agent is chloroform lini- 
ment, which may be applied on flannel over the lower 
part of the abdomen. The active counter-irritation thus 
produced will give relief. Should the spasm be very 
severe, the physician may apply pure chloroform sprin- 
kled on blotting-paper, for a few seconds, over the lower 
part of the abdomen until it well reddens the skin. 
Should no chloroform liniment be at hand, a warm flax- 
seed poultice may help to some extent, though not so 
efficient, as a rule. 



154 OBSTETRIC NURSING. 

A careful report should be kept by the nurse, from 
which the physician can learn all that has transpired in 
the intervals of his visits. 

Sheets of paper ruled and having headings, as in the 
plan on opposite page, are used in the Woman's Hospital. 

Observation of Symptoms. — The occurrence of 
pain, any complaint of chilliness or a decided chill, rise 
of temperature, rapid pulse, sleeplessness, headache, 
want of appetite, etc., should be carefully noted and 
brought to the physician's attention. 

For the first week or ten days it is well to take the 
temperature and pulse in the morning, at noon, and in 
the evening; after which, if the patient is doing well, 
the morning and evening temperature and pulse will be 
sufficient. 

Should the slightest complaint of chilliness be made, 
the nurse should place extra covers around the patient, 
hot-water bottles, if necessary, to warm her up, and at 
the same time give her a warm drink, as a cup of hot 
tea or even hot water. 

The temperature should always be taken after a com- 
plaint of chilliness, and taken quite frequently, as every 
hour or two, when, if it be found to be rising, a note 
should at once be sent to the physician, who may want, 
under the circumstances, to see the. patient at once or 
institute some new line of treatment. Pain may be tem- 
porarily relieved by the application of a hot flaxseed 
poultice. Grave inflammatory and septic troubles are 
ushered in by such symptoms as the above, hence no 



MANAGEMENT OF THE LYING-IN 



155 






S 



'INHWaAOW 

iHAvoa 



•HNina 



•asax 




•jwhx 




•asirid 




'anoH 



<; 



156 OBSTETRIC NURSING. 

time should be lost in notifying the physician of their 
occurrence. 

Puerperal Fever. — The use of blisters, poultices, 
packs, vaginal injections, and medicinal remedies re- 
quired in the treatment of the various forms of " puer- 
peral fever" must, of course, be in exact accordance with 
the physician's directions. 

Such troubles are generally septic, that is, arise from 
blood-poisoning ; and one very important duty of the 
nurse will be to see that the patient takes sufficient 
nourishment to combat the poison in the blood. 

Stimulants should never be given without a physician's 
advice, but when ordered great care should be exercised 
in their faithful administration. Egg-nog, milk-punch, 
whiskey-punch, wine-whey, milk in the various liquid 
and semi-liquid preparations, beef-tea, broths, etc., will 
be called for. The nurse should be ready with devices 
to tempt her patient to eat, and thus give the most im- 
portant aid to the arrest of the disease. The support of 
the strength, with extreme cleanliness and thorough 
antisepsis, will do much to arrest the course of the ter- 
rible maladies due to blood-poisoning. 

Puerperal Ulcers. — The existence of any sores about 
the vulva or vagina, when discovered by the nurse, 
should at once be reported to the doctor. These are 
especially dangerous when they take on a grayish sur- 
face, as this indicates that they have already become in- 
fected by poison. If the disease is not arrested here, 
the whole system may be involved. 



MANAGEMENT OF THE LYING-IN. 1 57 

Milk Leg. — A swelling of one or both legs some- 
times comes on after delivery. It is ushered in by acute 
pain and lines of redness accompanying the swelling — 
the vessels of the groin, under the knee, or in the leg, 
will often feel like cords. This is due to an inflamma- 
tion involving the veins. Sometimes blood clots form 
in the veins, which may be dislodged and carried to the 
heart and lungs, when they are the source of the 
gravest danger. Sometimes abscesses form in the leg. 
The great danger of clots being carried in the blood cur- 
rent makes absolute quiet imperative. The patient 
should lie flat on her back, and the limb be elevated on 
pillows or on an inclined plane, such as the fracture-box 
used in certain fractures of the lower extremity. 

The application of some soothing ointment, as iodin 
and belladonna ointment in equal parts, over the cord- 
like veins, a hot flaxseed poultice being kept over the 
ointment, will help to relieve pain and diminish inflam- 
mation. The whole limb should be kept warm by a 
wrapping of cotton batting. The limb is most comfort- 
able when slightly bent at the knee-joint. Should the 
weight of the bed-clothing cause pain a cradle may be 
made of barrel hoops for lifting them off the limb. The 
cradle is also very useful in cases of peritonitis when the 
same difficulty exists. 

Bed-sores. — Lying-in women should not be subject 
to bed-sores, but should some complication occur, as in 
some form of blood-poisoning, or should some other 
disease attack the patient during this time, necessitating 



158 OBSTETRIC NURSING. 

long lying, special care is necessary to prevent bed-sores. 
The parts of the body subjected to most pressure should 
be kept thoroughly dry and rubbed with alcohol and 
alum (a saturated solution) once or twice daily. A little 
cosmolin may then be rubbed into the skin, or some 
drying powder, as zinc or starch, may be used. When 
a sore occurs it must be dressed, according to the phy- 
sician's order, with zinc ointment or cosmolin. All 
pressure should be kept off it, if possible, by the adjust- 
ment of pads and pillows or a rubber-ring cushion. 

Puerperal Mania is a form of mental trouble which 
may affect lying-in patients, particularly when they are 
exhausted from any cause, whether it be mental worry 
or physical ill-health. In true mania the patient may be 
violent and very difficult to control. In the melancholic 
type of this trouble she is exceedingly depressed, dis- 
trusts her best friends, and cannot be roused to take an 
interest in her surroundings. 

As soon as it is noticed that the patient's mind is not 
well balanced the baby should be removed from the room, 
only being brought to the mother when asked for. 
The nurse should then keep a close watch over it, as 
one of the chief symptoms of this trouble is a strong 
aversion to the baby and desire to destroy it. 

It should never be forgotten that an insane patient 
slwidd not be left alone for a moment. The insane are 
very cunning, and though apparently asleep may be but 
watching their opportunity to indulge in some mad 
freak, as jumping out of the window, dashing down the 



MANAGEMENT OF THE LYING-IN. 1 59 

stairway and out of the doors, etc. The windows, there- 
fore, should be in some way protected. A nail or screw 
may be driven into the window-casing so as to prevent 
the raising of the sash, except so far as ventilation re- 
quires. The door had best be kept locked, the nurse 
keeping the key. 

The treatment will mainly consist in keeping up the 
nourishment and in kind, gentle, tactful management. 
The patient should be made to interest herself in outside 
things, by the judicious turn given to the conversation 
by the nurse, by engagement in some kind of fancy- 
work, or in games which will help to divert the mind. 

She should not be crossed, neither should she be de- 
ceived. The nurse should so manage her as to inspire 
a thorough confidence and liking toward her on the 
part of the patient. If she has not these, she had best 
give up the case, as she will not be able to help the 
patient. 

Should the patient absolutely refuse to eat, the physi- 
cian may direct the nurse to introduce the food into the 
stomach by means of a rubber tube passed through the 
nostril and down the esophagus, or gullet. Care should 
be taken to do no injury in the introduction of this 
tube, which should be well greased with cosmolin and 
made to follow closely the direction of the passages it is 
made to enter. A funnel is then connected with the 
outer extremity, through which the milk or broth, etc , 
may be poured into the stomach. 

Should the patient be exceedingly restless and dis- 



l6o OBSTETRIC NURSING. 

posed to jump out of bed, to her own detriment, she 
may be fastened into the bed by means of a sheet, 
doubled lengthwise, placed over the middle portion of 
the body from the arm-pits to below the knees and car- 
ried under the bed, to be fastened either beneath the bed 
or to one side of it. The feet may be bound together 
loosely at the ankles by a piece of roller bandage and 
fastened to the footboard of the bed. The hands may 
be bandaged together (being placed the one on top of 
the other) by means of a roller bandage, though this is 
not necessary except when they are used to do herself 
injury. Where patients are so violent as to need such 
restriction, however, it is better to have them removed 
to some institution for the insane as soon as possible, 
where there is better provision made for their manage- 
ment. The use of sedative remedies by the physician 
will generally prevent the necessity for resorting to such 
extreme measures for confining the patient in ordinary 
cases. 

Medicines should, of course, never be left in the 
patient's room, even when the nurse is there, unless 
under lock and key. The duration of this malady 
varies from weeks to months, in some cases becoming 
chronic. Convalescence is generally very gradual. 
Patients may have* long periods of lucid thought, and 
seem apparently well, only to unexpectedly return to 
their vagaries; so that the nurse should never relax 'her 
quiet vigilance while in charge of the case. 

The First Sitting-up. — The old time-honored belief 



MANAGEMENT OF THE LYING-IN. l6l 

that a woman should sit up on the ninth day is subject 
to many exceptions, which should be understood by the 
nurse as well as by the physician. The true gauge is the 
progress of involution. This may be determined by the 
height of the uterus (which ought to sink behind the 
pubic bone before the patient is allowed to sit up) and 
by the character of the discharges. So long as there 
is any blood in the discharges the patient should not sit 
up, for this is an indication that involution, or the shrink- 
ing of the womb, is not going on properly. This con- 
dition is known as " sub-involution'' and if neglected 
may lead to chronic disease of the womb. The use of 
the recumbent or semi-recumbent posture, frequent hot 
injections given by the nurse, or remedies administered 
by the physician, may be necessary to overcome it. Let 
the patient understand the wisdom of her confinement 
to bed under such circumstances, and she will generally 
yield gracefully to the necessity. The first sitting-up 
should be in bed, the patient's back being supported by 
a bed-rest. Should no bed-rest be found in the house, 
a chair turned upside down, with its back toward the 
patient, over which a pillow is placed, offers a very good 
substitute. 

After sitting up in bed for a day or two, from a half- 
hour to an hour if there be no discharge, the patient 
may have her flannel wrapper and stockings and bedroom 
slippers put on, and be allowed to sit up in an easy 
chair. It must be remembered that this is the time 
when the patient will be most susceptible to cold, there- 
ii 



1 62 ' OBSTETRIC NURSING. 

fore every precaution must be taken to prevent her ex- 
posure to draughts. Should the patient seem to grow 
tired before the half-hour or hour is up, she should be 
put back in bed. The interval for sitting up may be 
gradually increased from day to day, until she is up the 
greater part of the day. No going up and down stairs 
should be permitted until the physician sanctions it, 
which is, in ordinary cases, about the fifth, or sixth 
week, when one such journey a day is generally per- 
mitted. 

Order Board. — That there may be no misunderstand- 
ing between physician and nurse, the orders of the phy- 
sician in every case should be immediately set down in 
writing when given, so that by constant reference to 
them the nurse may do her full duty by the patient. It 
is well, for this purpose, to have a piece of paper ruled 
so that at the right side there shall be two columns, one 
headed A. M., the other P. M. The stated hours for the 
administration of medicine or carrying out of treatment 
may then be placed opposite the special directions for 
each, and a pencil mark be drawn through the figure 
representing the hour when the matter has been at- 
tended to. 



MANAGEMENT OF THE LYING-IN. 



163 



An order board, as used in the Woman's Hospital, is 
prepared as follows : — 



Orders for Treatment of Mrs. Richards, Oct. 


10, 1889. 




A.M. 


P. M. 


Full breakfast, dinner, and supper, ... ... 

A teaspoonful of medicine (light or dark), .... 

Sponge bath, 


6 

6.3O 

IO 

9 


12, 6 
I2.3O, 6.3O 


Lunch of gruel or beef-tea, 


3 

8 
2 


Glass of milk at bedtime, 

To sit up half an hour with bed rest, 



Nurse's Name. 



A fresh board should be prepared for each day's work. 
In ordinary cases, which run an uneventful course, these 
boards, with the hours crossed off, serve the purpose o 
a report as well. 



CHAPTER XII. 
CARE OF THE NEW-BORN INFANT. 

The mother being made comfortable after her delivery, 
the nurse should turn her attention to the infant. 

First Toilet. — Everything needed for the baby's first 
toilet should be collected and placed conveniently at 
hand, near the register, stove, or open fireplace. 

The nurse should put on a flannel apron, or pin a crib- 
blanket or flannel petticoat over her lap. The best bath- 
apron is one consisting of two pieces of flannel fastened 
to the same waistband. The lower piece is the one on 
which the baby lies ; the upper serves as a covering. 
A pitcher of warm water and one of cold must be 
provided, the baby's bath-tub being placed near them, 
the baby-basket, suit of aired clothing, and jar of 
rendered lard or oil within reach. The nurse should 
pick the baby up with its wraps and place it in 
her lap as she seats herself on a low chair or stool near 
the fireplace. 

The baby will be found to be covered over portions 
of its body by a white, greasy substance, called "vernix 
caseosa," or " cheesy varnish." This substance is found 
in greatest quantity on portions of the body subjected 

164 



CARE OF THE NEW-BORN INFANT. 1 65 

to friction while in the womb, hence it serves to protect 
the child's skin. 

Some kind of grease is needed for its removal. Ren- 
dered lard and oil are the best. Cosmolin is not so 
good, as it is stiffer than the other two — not so soluble 
a fat. All this cheesy substance must come away with 
the first washing, as, if left, it irritates the skin and pro- 
duces sores. The most difficult parts of the body to 
cleanse are the folds or creases. The nurse should take 
a piece of lard about the size of a walnut, rub it over the 
palms of both her hands, and then, taking the child's 
head between her hands, rub the grease thoroughly in, 
giving especial attention to the ears. A second piece of 
lard of the same size will be needed for the neck, 
shoulders, arms, chest, and back ; a third piece for the 
groin, external generative organs, and lower limbs. The 
creases and folds about the generative organs, especially 
of a little girl baby, need very careful cleansing. When 
the baby has been thus thoroughly gone over, she 
should take the corner of a dry sheet and rub off the 
grease. Many physicians prefer not having the baby 
bathed after this greasing. It may then be dressed and 
laid in its crib. 

Should the bath be preferred, the nurse should wrap 
the baby up in her flannel apron, draw the bath-tub 
toward her, and prepare the bath, filling the bath-tub 
about one-third full of warm water at a temperature of 
ioo° F., tested by the thermometer. A wall-thermom- 
eter, costing fifteen cents, may be obtained at any drug- 



1 66 OBSTETRIC NURSING. 

store for the purpose. The baby is then placed in the 
tub, its entire body, excepting its head, being immersed 
for a moment or two beneath the water. The nurse 
should keep the baby from slipping from her grasp by 
allowing its head to rest against her left wrist and hand, 
while the fingers of the same hand obtain a secure grasp 
under the child's left arm-pit. After the dip, the child 
is lifted out on to the nurse's lap again, where a soft, 
warm towel should have been spread for its reception. 
In this it should be wrapped and thoroughly dried. 
Great care must be taken to see that the arm-pits, groins, 
and other parts of the body where creases exist are en- 
tirely free from moisture. After the first bath, the child 
receives, as a rule, but a sponge-bath daily until the 
cord drops, when the daily plunge-bath may be given. 
The baby should always be thoroughly washed with 
simple warm water over the parts of the body soiled 
every time the napkin needs to be changed. Soap does 
not need to be used. Its frequent use would irritate the 
skin, and the parts can be perfectly cleansed without it. 
The use of powder in the folds and creases of the 
body is not essential. The main object is to keep rub- 
bing surfaces dry, and should the nurse properly attend 
to this duty after the bath, this, with the use of flannel 
next the baby's skin, ought to be sufficient to effect the 
purpose. Should a powder be desired, some very fine, 
unirritating powder, such as lycopodium, might be used. 
Many of the scented powders contain substances which 
are irritating to the skin. 






CARE OF THE NEW-BORN INFANT. 1 67 

Dressing the Cord.— -After the baby has been dried, 
the stump of the cord or navel-string should be attended 
to. Make a loop of the stump, doubling it back upon 
itself, and tying it tightly by means of the ends of the 
bobbin left from the first ligature. Slit up a square of 
soft linen to its center. It is well to have rendered this 
antiseptic by dipping in a bichlorid solution i-iooo or 
2000 before drying. Put this around the cord, which is 
slipped through the slit (the slit looks upward toward the 
child's head), fold over the ends, and turn the whole 
upon the left side. Some physicians will direct that no 
dressing be placed around the cord. In fact, sometimes 
there is no ligature placed around it, but it is simply well 
stripped of the blood and jelly-like substance which help 
to compose it, and thus allowed to dry. 

The placing of the loop of cord with its dressings on 
the left side of the child's body is to avoid pressure upon 
the liver, which is larger than any other organ in the 
infant's body at birth, so large, in fact, as to extend quite 
down to the navel. The abdominal bandage is put on 
over the dressing to hold the latter in place. 

Some use antiseptic gauze or cotton in the dressing 
of the cord. A drying powder, consisting of one part 
salicylic acid and five parts starch, is an antiseptic appli- 
cation which it is desirable to employ. 

A clear substance exudes from the cord as it shrinks 
which wets the dressings, so that it is necessary to 
change the piece of linen quite often the first day or two. 
A cord kept dry by the frequent change of dressings 



1 68 OBSTETRIC NURSING. 

will have no odor about it, and will drop, on an average, 
by the fifth day. The base from which the cord dropped 
may continue moist for a few days, and is best dressed 
by dusting over it a little of the starch and salicylic acid 
powder before spoken of, and placing a small compress 
of antiseptic linen or gauze over it. The navel-dressing 
is kept in place by the application of the flannel binder, 
which should be carefully adjusted, so as not to com- 
press the abdomen too tightly. After the bandage is 
fastened, the nurse's hand, used flatwise, should be easily 
slipped in between the bandage and the baby's skin. 
Should safety-pins be used in fastening the bandage, 
they should be placed in front and not at the back, or 
they may cause the baby discomfort in lying. The 
bandage fastened by the tapes, which is simply wound 
around the body, is safer on this account. 

Great importance should be given to the proper care 
of the navel, as it offers an open surface on the child's 
body through which poisonous matter may be taken into 
the blood, causing " infantile sepsis," or the blood- 
poisoning of infants. 

Meconium. — Before the dressing of the cord, a nap- 
kin should have been laid beneath the hips of the infant, 
as there is very apt to be a free discharge of a dark, 
greenish matter from the bowels shortly after the birth. 
This is known as " meconium." It should always come 
away within the first twenty-four hours after birth, and 
may continue to come at intervals for three or four days. 
When it does not come away freely the baby may suffer 



CARE OF THE NEW-BORN INFANT. 169 

considerable pain. A soap suppository or a small injec- 
tion of warm water will bring about relief, causing an 
evacuation of the bowels. 

This substance is very difficult to wash out of napkins, 
hence, it is a good plan to have a soft piece of old 
muslin placed inside the napkin to catch the discharge. 
This^nay be burned when removed. 

Cleansing. — The baby should be washed every time 
the napkin needs to be changed, even if it is only wet. 
Warm water should be used. A napkin should never 
be used twice without washing. The habit of hanging 
up a napkin wet with urine, allowing it to dry, and 
using it again, is not only filthy, but unsafe, as it renders 
the napkin irritating to the skin and a source of possi- 
ble septic infection. For the same reason a napkin 
should be changed as soon as it is wet or soiled. 
Though the work may be irksome, a nurse should not 
weary of it ; for it is only by eternal vigilance that the 
child can be kept in good condition. 

Clothing. — After the application of the binder and 
napkin, the baby's under-vest, or little, long-sleeved, 
high-necked flannel shirt, should be put on. This 
should be fastened in front by safety-pins, or small, flat 
buttons or tapes. 

If the shirt is too large, folds should be made at the 
sides to make it fit better ; never in the back, because 
of the ridge this would produce under the surface upon 
which the baby lies. 

The socks come next and then the flannel slip, con- 



170 OBSTETRIC NURSING. 

stituting the only other garment the baby needs. The 
petticoat with slip, or Gertrude suit, may be used in- 
stead, if desired. 

Eyes and Mouth. — The eyes and mouth should each 
be washed out with a separate soft piece of linen dipped 
in warm water. 

The Baby's Hair, if it has any, may be brushed with 
a soft baby-brush. No comb should be used, as the 
scalp is too tender. 

After-care. — The baby should then be placed in its 
crib, on its right side, and warmly covered. The weaker 
the baby is, the warmer it will need to be kept. Stone 
jars, when filled with hot water, are nice for this purpose 
placed around the child, but care should be exercised 
not to let these bottles be placed so near as to cause a 
burn. 

In another chapter we will consider the care of pre- 
mature infants. 

The weighing of the baby devolves often upon the 
nurse. A steelyard being provided, the nurse may 
place the nude child in a napkin, tied or pinned securely 
at the corners. This napkin may be swung on to the 
hook of the steelyard as it is held up. The pointer will 
then indicate the number of pounds weight. The aver- 
age weight of a new-born baby is 3250 grams (about 
seven pounds). 

In the Woman's Hospital the ordinary grocer's pan- 
scales are used, the weights being represented in grams. 
The daily weight is taken and recorded on a card which 



CARE OF THE NEW-BORN INFANT. 171 

hangs by a ribbon or string to the baby's crib, so that its 
daily condition may be carefully watched. For a com- 
parison of the approximate weights in the metric and 
avoirdupois scales, I append the following table of 
equivalents : — 

Relation of Avoirdupois to Metric Weights. 



AVOIRDUPOIS GRAMS. 
POUNDS. 

1 453-592 

2 907.18 

3 1360.78 

4 1814.37 

5 2267.96 



AVOIRDUPOIS GRAMS. 
POUNDS. 

6 2721.55 

7 3I75-I4 

8 3628.74 

9 4082.33 

10 4535-92 



For the first three or four days a baby will lose 
weight, as it does not take in enough nourishment to 
make up for the loss it sustains by the newly-acquired 
activity of bowels, bladder, and skin. At the end of the 
first week the baby should weigh about what it did at 
the birth. After that it should gain, on an average, 
thirty grams a day (about one ounce) for the first two 
months of its life. 

A Sponge-Bath is sometimes given the baby at the 
close of the day, when its clothing is changed for the 
night ; but this is not necessary, if it has been properly 
attended to when the napkins have been changed. The 
fresh clothing at night is always essential. 

The Baby's Crib should have no rockers, All un- 
necessary swinging, rocking, and jolting of babies only 
serves to make them nervous and more troublesome to 
take care of. A convenient and inexpensive crib and 



172 



OBSTETRIC NURSING. 



bath-tub combined, especially for traveling, is described 
in one of the numbers of " Babyland," thus : " The 
frame is made something like a cot-bed. Straight pine 
sticks may be used. The legs, one inch and a half 
square by thirty inches long, are crossed and pivoted in 
the middle on a center bar. The side bars, one inch by 
two inches, and thirty-six inches long, are securely fast- 
ened to the top of the legs. Smaller bars join the legs 




Fig. 30. — Home-made Bath-tub and Crib. 



near the bottom to stiffen the frame. A piece of heavy 
rubber-cloth, one yard and a quarter long and thirty 
inches wide, has an inch-wide hem on each end for a cas- 
ing, and is drawn up to eighteen or nineteen inches with 
heavy braid (a leather strap would probably be better). 
This makes the ends of the tub. Along the side bars of 
the frame are tacked with brass-headed tacks the sides 
of the cloth, the braid (or rubber straps) being securely 



CARE OF THE NEW-BORN INFANT. 1 73 

fastened to the ends. A small plait in the cloth at each 
corner, about an inch from the end, gives a fuller shape 
to hold the water (when it is in use as a bath-tub). The 
tub (or crib), when not in use, can be folded and set away 
out of sight, or it may be carried in the bottom of a 
large traveling-trunk when on a journey. The frame 
may be made of walnut or cherry, with turned legs, etc., 
if so desired. A pillow put in the tub makes a comfort- 
able and portable crib for the baby. 

Children should never sleep in the same bed with their 
mothers. It is unsafe because there is danger of their 
being overlaid, and it is unhealthy because of the dis- 
charges, breath, etc., of the mother. 

Tubs for Babies. — Many varieties of tubs are made 
for babies, of tin or agate-ware, or porcelain. A painted 
tin foot-tub serves a good purpose while the child is 
small. These may be placed upon a bath-stand or low 
chair to prevent the necessity of too much stooping on 
the part of the nurse while bathing the baby. 

Training of a Baby. — A baby may be trained to be 
contented and happy as it lies in its crib. If from its 
earliest days it is taken up simply to be fed, and receive 
the necessary attentions for keeping it clean and com- 
fortable, it will not become the little tyrant a child de- 
velops into when foolishly spoiled by it's mother. 

Feeding of Infants. — Babies should be fed but once 
in two hours during the day, and every three hours during 
the night, unless premature, when they can take less and 
should be fed every hour. An interval is necessary be r 
tween the feedings in order that the stomach may rest 



174 OBSTETRIC NURSING. 

and be prepared properly to carry on its work of diges- 
tion. Hence, the habit some mothers have of letting 
babies nurse whenever they cry simply serves to produce 
indigestion, as well as to spoil the child.* 

For its first nursing the baby may be put to the breast 
an hour or two after the labor, if the mother is suffi- 
ciently rested. The nipples should, before each nursing, 
be carefully washed off with cold water. The early 
secretion of the breasts, known as " colostrum," helps 
to rid the baby's bowels of their dark, tarry contents, as 
it is laxative. It is important that the breasts should 
be used alternately in feeding the infant, as this allows a 
longer time to elapse for the accumulation of milk. For 
the first day or two the baby needs comparatively little 
food. Should it seem to be hungry, however, and the 
mother unable to satisfy it, a teaspoonful or two of warm 
water or diluted peptonized cow's milk, prepared accord- 
ing to the suggestions to be given later, may be admin- 
istered at regular intervals. 

Before and after each feeding, the baby's mouth 
should be carefully washed out with apiece of soft linen 
dipped in warm water or a saturated solution of boric 
acid. This is to prevent the particles of milk remaining 
in the mouth from producing soreness by souring. 

Two or three times daily a baby should be given a 
teaspoonful of cold water to drink, as babies suffer from 



* It has been observed that when the periods between nursing were short 
the milk was more condensed, a fact which throws light on the dyspeptic 
phenomena occurring in babies who are fed too often. — Rotch. 



CARE OF THE NEW-BORN INFANT. 1 75 

thirst just as their elders do. The cold water assists, 
also, in keeping the bowels from becoming constipated. 
The water should be boiled and kept in an air-tight flask. 

Insufficient Milk. — Should the mother not have suf- 
ficient milk for her baby, it may have the bottle every 
other time, the additional food being selected with refer- 
ence to the child's age and powers of digestion. 

The'Wet-nurse. — When a mother has no milk, the 
best substitute is a good wet-nurse. A wet-nurse should 
always be carefully examined by a physician, that her 
freedom from disease may be fully determined before she 
is employed. She should be between twenty and thirty 
years of age, and have good, not necessarily large, 
breasts, well-shaped nipples, and an abundant supply of 
milk. The condition of her own child should be con- 
sidered, whether it be thriving or sickly, and especially 
whether there be any evidence of special disease. It is 
well, too, to try to get a woman who has had more than 
the one child, as a woman who has borne several chil- 
dren has, by experience, learned to understand and 
manage babies. 

Lactation. — The first milk that comes in the breast, 
and which appears in any quantity, about the eighth 
month of pregnancy, is called " fore-milk," or " colos- 
trum," from a word which means " glue." It is turbid, 
yellowish, gluey, alkaline in reaction, and easily sours. 
It differs from true milk in having a higher specific 
gravity or weight ; it also contains more salts and more 
albumen, and is more difficult to digest. It is laxative 
in its effect upon the baby's bowels. Physicians not 



176 OBSTETRIC NURSING. 

unfrequently examine a specimen of this secretion under 
the microscope, to learn what the prospect is as to the 
mother's nursing the child. If, in the last two months 
of pregnancy the colostrum is scanty, and under the 
microscope there are but few oil globules, the patient 
will probably have poor milk and small in quantity. If 
the colostrum is abundant but thin, like gum water, not 
gluey and without yellowish streaks, it is probable that 
the milk will be watery and not nourishing. It may be 
either scanty or abundant. If the colostrum be plenty, 
with yellowish streaks and full of milk globules, the 
milk will be abundant and good in quality. The secre- 
tion of colostrum may continue from six to eight days. 
If it continues longer it is a great disadvantage, and 
the mother may have to give up nursing because of 
the child's inability to digest the nourishment thus 
afforded. 

Human milk should have a specific gravity of 1020- 
1034. It is slightly alkaline in reaction ; that is, it will 
turn red litmus-paper blue, and it contains the following 
ingredients : — 

Water,* 87-88 

Total solids, 13-12 

Fat, 3-4 

Albuminoids, 1-2 

Sugar, 7.0 

Ash, 0.2 

— Rotch. 

* According to the analyses of Dr. H. Leffmann the percentage of fat 
rarely reached 4, ranging between 2.5 and 3 as a rule, while the albumi- 
noids were usually a fraction over 1 per cent. 



CARE OF THE NEW-BORN INFANT. 1 77 

It differs from cows' milk in having a higher specific grav- 
ity, more solids, less water, and one-fifth the amount of 
albuminoids. The milk retained longest in the breast — 
the first milk drawn by the baby at each nursing — is the 
thinnest ; the last, the richest. When, therefore, a baby 
seems to suffer from indigestion because of its mother's 
milk being too rich for it, it should take the first secre- 
tion from each breast at each nursing instead of drawing 
all the milk from one breast. One or two teaspoonfuls 
of water given the baby before each nursing have the 
same object. Should it, on the contrary, not seem to 
thrive because of the food not being sufficiently rich, the 
thin milk should be pumped or drawn out of each 
breast by the nurse or mother before the baby is allowed 
to draw. The two breasts are estimated to contain 
about two ounces of milk at one time.* 

The question of how to increase the secretion of milk is 
a very important one. The best way is by a judicious 
regulation of the mother's or wet-nurse's diet. There 
are no medicines which are entirely satisfactory for the 
purpose of stimulating the secretions. Therefore a nurse 
can do more than a doctor in this line by careful feeding 
of her patient. A mixed diet is the best for making 
milk. Beer and all kinds of liquors, as porter, etc., do 
more to fatten the mother or nurse than to make milk ; 



* The use of from 1-5 drops of cod-liver oil, according to the age of the 
child, given three times daily, has been found to be a valuable supplement 
to the food when a mother's milk lacks richness. — Dr. A. E. BroomalL 

12 



i 7 8 



OBSTETRIC NURSING. 



therefore they are to be avoided. In weakly women 
with poor appetites the malt liquors and bitter tonics are 
sometimes of advantage in stimulating the appetite and 
thus promoting a greater secretion of milk. The spe- 
cial diet for a nursing woman is laid down in another 
chapter. Good human milk should be three per cent, 
cream.* 

To determine the character of milk — human or cows' 
milk — an instrument known as the lactometer, or milk- 
tester, may be used, aided by the microscope. 

The Lactometer consists of a cylin- 
drical glass vessel, or beaker, which 
should contain the milk to be tested, 
and a specific gravity glass, which is to be 
floated in the liquid. This glass is grad- 
uated and marked at certain points with 
certain letters and figures. Thus, W., 
P., and F. The W. stands for " water," 
P. for " pure," and F. for " fat." Be- 
tween the W. and P., at different points, 



fC 




are the fractions, 



'4> 



Should 



Fig. 31. — Lactometer. 



the weighted glass sink in the liquid so 
that the surface of the liquid reached 
the mark W., the liquid tested would 
have the same specific gravity as water. 
Should the surface of the liquid reach the mark *^, if it 

* As a general rule, the amount of fat may be increased by increasing the 
amount of meat in the diet, and the amount of albumin decreased by mod- 
erate exercise. Too little fat and too much casein make poor milk. — Rotch. 



CARE OF THE NEW-BORN INFANT. 1 79 

is milk that is tested, it would be ^ milk and ^ water. 
If the mark y 2 is touched, it is y 2 water and ]/ 2 milk. 
In this way the adulteration of the milk with water is 
detected. Should the level of the liquid stand at P., we 
would have pure milk. Pure cream would raise the 
weighted glass so that the level of the liquid would stand 
at F. An ordinary urinometer may be used to obtain 
the specific gravity of milk in a similar way. Dr. Louis 
Starr suggests a good way to discover the proportion 
of cream in any given sample of milk : A narrow piece 
of paper, four inches long, is divided in its upper half 
inch by cross-markings into twelve equal parts. This 
paper is then pasted on the beaker of the lactometer 
with the marked portion uppermost, the lower edge 
touching the bottom of the beaker. Enough milk is then 
poured in to come just to the top of the paper, and the 
whole set aside for twenty-four hours. The cream rises 
and appears as a yellow layer at the top. This layer 
should have the depth of ten or twelve spaces, as marked 
on the paper. There is an inexpensive instrument known 
as the creamometer which serves the same purpose in 
determining the amount of cream in milk. 

On examination under the microscope, if there are 
but few oil globules in a specimen of milk, and if these 
oil globules be small, the milk is poor. On the other 
hand, if the oil globules in milk are too large, this be- 
comes a cause for its indigestibility. 

Should menstruation begin with a nursing mother, the 
milk may be so affected as to disagree with the child. 



i8o 



OBSTETRIC NURSING. 



Ordinarily, the menstrual flow does not recur until the 
eighth month after delivery. The appearance of the flow 
need not lead to a cessation of nursing, unless the milk 
should seem to disagree with the child. The character 
and quantity of the milk is impaired by deep or violent 
emotions ; thus, anxiety, fear, anger, etc., will greatly 
detract from a woman's ability to be a good wet-nurse. 
Pregnancy always deteriorates the character of milk and 
is an indication for weaning a nursing child. 

Hand Feeding. — When the mother's milk utterly 
fails, and a wet-nurse cannot be had, hand-feeding be- 
comes necessary. For this purpose diluted sterilized 
cows' milk may be used. 

Cows' Milk has a specific gravity of 1.029. The 
milk obtained from stall-fed cows gives an acid reaction ; 
that from pasture-fed cows a less acid reaction. Could 
the latter be obtained directly from the cow its reaction 
would be slightly alkaline, as with human milk. An 
analysis of the same, quantity of woman's milk and 
cows' milk is reported as yielding the following 
results : — 

Woman* s Milk. Cows* Milk. 

Water, 87.88 parts. 86.87 parts 

Total solids, .... 12.13 " 13. 14 " 

Fat, 4.00 " 4.00 " 

Albuminoids, . . . 1.00 " 4.00 " 

Milk-sugar, .... 7.00 " 4.5 " 

Ash, 0.2 " 0.7 " 

Bacteria not present. present. 



The woman's milk for this analysis was obtained 



CARE OF THE NEW-BORN INFANT. l8l 

directly from the breast. The cows' milk was, as it is 
ordinarily obtained in cities, about twenty-four hours 
old. 

By an examination of this analysis, it will be seen 
that the proportion of coagulable substances of cows' 
milk is much greater than in human milk. This is 
where the difficulty in its digestion lies. Casein of 
human milk coagulates in light curds; in cows' milk in 
firm, hard curds. 

Quality of Food. — The kind of food required by dif- 
ferent babies will vary with their constitutions. As a 
rule, a mother's milk is the best food for her child, and 
makes a good gauge to start from in the preparation of 
an artificial food to take its place or act as a supplement 
when there is an insufficient supply. If, therefore, a 
careful analysis is made of a mother's milk and a mix- 
ture prepared which shall, so far as possible, contain the 
same constituents in the same proportion, we may hope 
that the baby will thrive on it. A steady increase in 
the baby's weight will be the best index by which we can 
judge of the nutritive qualities of the food it is taking. 

Increase in Weight. — For the first four or five 
months of its life, a child should gain on an average 
twenty to thirty grams (about one ounce) daily. For 
the remainder of the first year of life, a daily gain of 
from ten to fifteen grams will mark satisfactory prog- 
ress. 

In the comparatively few cases in which a mother's 
milk does not appear to have proper nutritive or digest- 



1 82 OBSTETRIC NURSING. 

ive properties, it should be similarly examined to dis- 
cover in what direction the deficiency lies, and the 
artificial food should be prepared so as to supply the 
lack. The nutritive constituents of milk are the albu- 
minoids, fat, and milk-sugar. 

Humanized Cows' Milk. — Cows' milk contains about 
four times the quantity of albuminoids found in human 
milk, so that it requires to be diluted with four times as 
much water to represent the same percentage of albu- 
minoids. Since the amount of fat in human and cows' 
milk are about equal, this dilution would greatly de- 
crease the percentage of fat. Also, since cows' milk 
contains a much smaller quantity of sugar of milk than 
is found in human milk, the same dilution would be 
greatly deficient in sugar. % 

In preparing a mixture from cows' milk, therefore, 
which may correctly represent human milk, fat, in the 
form of cream, and sugar of milk must be added. 

Cream varies very much in richness, hence it is de- 
sirable to know what percentage of fat is represented 
by the cream used in compounding a mixture. A 
chemical analysis of the cream is necessary for accuracy 
of result in such determination. It has been suggested 
that to prevent too much variation in the percentage of 
fat, the cream should be obtained of the same person 
from milk that has been allowed to stand each day for 
the same length of time and in the same temperature. 

A mixture made up according to the following rule 
probably most nearly resembles the average human 



CARE OF THE NEW-BORN INFANT. 1 83 

milk. To make one pint of the mixture for use in twenty- 
four hours, take milk and cream (twenty per cent.) as 
soon as it comes in the morning, and mix as follows : — 

Milk, fgij 

Cream, f^"J 

Water, fgx 

Milk sugar, 3 6}£ 



Put in a flask in the steamer and steam for twenty min- 
utes ; then remove the flask from the steamer, and when 
still slightly warm add lime-water f§j. Place on ice, 
and give the proper amount at the proper feeding time, 
warming the quantity of the mixture used in a water- 
bath before giving it to the baby. (Rotch.) 

The object in steaming the mixture is to sterilize it, 
for human milk is sterile, and for that reason more 
digestible . than cows' milk — which, although sterile 
while in the udder, becomes contaminated as it is placed 
in vessels and transferred from place to place. It is be- 
lieved by some that this steaming or boiling of milk 
has a tendency to decrease its digestibility. The danger 
from this source, however, is probably much less than 
that which would arise from the presence of germs in the 
milk, such as have been shown to exist. " Fractional 
sterilization," the heating of milk in a water-bath several 
times in succession up to a more moderate degree of 
heat than that required for complete sterilization (167 
F.), is said not to have the same effect in decreasing the 



184 OBSTETRIC NURSING. 

digestibility of milk. The process, which is known as 
Pasteurization (after the French scientist Pasteur), is a 
modification of sterilization, the temperature of the 
milk being brought up only to 167 Fahrenheit instead 
of to 212° which is done in sterilizing. It is claimed 
that; this process destroys the germs sufficiently for all 
practicable purposes. It does not, however, with cer- 
tainty kill the germs, hence, a method has been sug- 
gested by which the milk can be brought to a higher 
degree of heat, and yet not lose its digestibility. 

The bottles of the sterilizer are filled and the apparatus 
made ready in the usual way, but the hood is left off 
and the lid set ajar, while the heating is continued for 
forty-five minutes over a brisk fire. The temperature of 
the milk is thus brought up to about 190 . It has been 
found that milk thus prepared and kept in well corked 
bottles will keep sweet for twenty-four hours. 

Lime water is added to make the mixture alkaline, all 
human milk being slightly alkaline. It should not be 
placed in the flask before boiling or steaming, because 
experimentation has shown that the lime undergoes 
some change in the process of boiling, which causes a 
discoloration of the milk and the deposit of a sediment. 
Experiment has shown that water is the most efficient 
diluent to be employed in making these mixtures, as it 
gives a much finer curd with acids, when so used, than 
can be obtained by an admixture with barley-water or 
any of the prepared foods. 



CARE OF THE NEW-BORN INFANT. 



185 



Having thus determined by analysis the quality of the 
food required for an infant, the quantity must be deter- 
mined and frequency of feeding. 

As to Quantity, the observations made by Dr. Ssnit- 
kin, of St. Petersburg, have led to the formulation of a 
rule by which one one-hundredth of the baby's weight 
should be taken as the figure with which to begin the 
computation, and to this should be added one gram 
for each day of life. 

A table prepared by Dr. Rotch, of Boston, has 
arranged in very convenient form the quantity and inter- 
vals of feeding for the first year of a child's life : — 



GENERAL RULES 


FOR FEEDING. {Rotch.) 


Age. 


Intervals 

of 
Feeding. 


Number 

of 
Feedings 

in 
24 Hours. 


Average 

Amount at 

Each Feeding. 


Average 
Amount in 
24 Hours. 


1st week. 


2 hours. 


IO 


I ounce. 


10 ounces. 


1-6 weeks. 


2^ hours. 


8 


ij^-2 ounces. 


12-16 ounces. 


6-12 weeks and 

possibly 

to 6th month. 


3 hours. 


6 


3-4 ounces. 


18-24 ounces. 


At 6 months. 


3 hours. 


6 


6 ounces. 


36 ounces. 


At 10 months. 


3 hours. 


5 


8 ounces. 


40 ounces. 



186 



OBSTETRIC NURSING. 



Another table arranged by Dr. Rotch shows the 
amount required at each feeding, according to the weight 
of the child. 

DETERMINATION OF AMOUNT OF FOOD BY WEIGHT IN 
CASES OF SPECIAL DIFFICULTY. 



Initial 


Each Feeding. 


Weight. 


EARLY DAYS. 


AT 15 DAYS. 


AT 30 DAYS. 


3000 
grams. 


30 grams. 
(About 1 ounce.) 


30+15=45 grams. 
(About \]/ 2 ounces.) 


30 + 30 = 60 grams. 
(About 2 ounces.) 


4500 
grams. 


45 grams. 
(About iji ounces.) 


45 + 15=60 grams. 
(About 2 ounces.) 


45 + 3°= 7 5 grams. 
(About 2^ ounces.) 


6000 
grams. 


60 grams. 
(About 2 ounces.) 


60+15 = 75 grams. 
(About 2 l / 2 ounces.) 


60 + 30 = 90 grams. 
(About 3 ounces.) 



Stomach of Infant. — A new-born infant's stomach 
holds about 1 y 2 ounces. The average daily quantity of 
food required for the first 2-3 months is 20 ounces ; 
after 3 months, 23 ounces ; after 4 months, 27 ounces; 
6-12 months, 30 ounces. The child's appetite, however, 
if it be healthy, is a good gauge. During the first 
month I ]/ 2 ounces of the prepared cows' milk may be 
given at each feeding, and twelve feedings given daily. 

Peptonized food diluted has been employed with 
great success by some physicians where the digestive 
powers in early childhood seemed at fault. The follow- 
ing formula may be used for the purpose : — 

Into a clean quart bottle put one measure, or five 



CARE OF THE NEW-BORN INFANT. 1 87 

grains, of extractum pancreatis (Fairchild's), and one 
measure, or fifteen grains, of bicarbonate of soda, and a 
gill of cold water ; shake, then add a pint of fresh cold 
milk, and shake the mixture again. Place the bottle in 
water about no° or 115 , or so hot that the whole hand 
can be held in it without discomfort for a minute. Keep 
the bottle there for twenty minutes. At the end of that 
time put the bottle on ice to check further digestion and 
keep the milk from spoiling. 

If heat cannot be conveniently provided, after the in- 
gredients have been thoroughly mixed and shaken, the 
bottle may be placed on ice and allowed to stand for an 
hour before it is used. 

It must be remembered that peptonized milk cannot be 
sterilized or it becomes unfit for food — the process of 
digestion being carried so far as to curdle the milk and 
render it extremely unpalatable. Sterilized or Pasteurized 
milk may, however, after it has cooled, be peptonized. 

If an additional aid to the digestion should be neces- 
sary, a little pepsin may be given to the child just before 
each feeding, or the pepsin may be placed in the nursing 
bottle just as the child takes it. Pancreatic extract and 
soda, if used, will need to be given about an hour after 
the meal. 

A preparation of peptonized milk, which has been 
much used by Dr. Broomall, is the following : — 

Peptonized milk, 6 tablespoonfuls 

Milk-sugar, Y^ teaspoonful 

Barley water, 2 tablespoonfuls 

Lime water, r ...... 1 tablespoonful. 



1 88 OBSTETRIC NURSING. 

Another favorite formula in Philadelphia is that of Dr. 
Meigs, known as Meigs' Food : — 

2 parts cream. 

1 part milk. 

2 parts lime water. 

3 parts sugar water. 

The sugar water is prepared by putting eighteen table- 
spoonfuls milk sugar to a pint of water. 

Dr. Louis Starr gives a very useful dietary for infants, 
which has also met with great success. Those formulae 
which especially concern the obstetric nurse are as 
follows : — 

Diet for first week : — 

Cream, 2 teaspoonfuls 

Whey,* 3 teaspoonfuls 

Water (hot), • • • 3 teaspoonfuls 

Milk sugar, ^ teaspoonful. 

for each portion ; to be given every two hours, from 5 
a. m. to 11 p. m., and in some cases once or twice at 
night, amounting to twelve fluid ounces of food per day. 
Diet from the second to the sixth week : — 

Milk, I tablespoonful 

Cream, 2 teaspoonfuls 

Milk sugar, % teaspoonful 

Water, 2 tablespoonfuls. 

for one portion, to be given every two hours, from 5 a. m. 

* Whey is made by the use of rennet or by adding three teaspoonfuls of 
wine of pepsin to a quart of warm, fresh milk, and placing the mixture near 
the fire for two hours. The curd is removed by straining through muslin. 



CARE OF THE NEW-BORN INFANT. 1 89 

to 1 1 p. m., amounting to seventeen fluid ounces of food 
per day. 

The proportion of milk in the mixture and the quan- 
tity given at one time are carefully increased during the 
succeeding weeks. Not until it is about twelve months 
old can a baby well take undiluted cows' milk. When 
milk cannot be borne, diluted cream one part to five or 
six of water, or barley water, makes a serviceable mix- 
ture, or cream and whey may be combined thus : — 

Cream, I ounce 

Whey, 2 ounces 

Warm water, 2 ounces 

Milk sugar, I teaspoonful. 

[Griffith.) 

For those unable to follow any elaborate formulae, the 
following plain directions for making cows' milk resem- 
ble human milk may be given : — 

Take of " top milk " (the upper portion of milk which 
has been allowed to stand in a suitable place six to eight 
hours) one part, and add to this two parts of water or 
barley water. This gives about the same proportion of 
cream and curd as in mothers' milk, but lacks sugar. 
Milk sugar (obtainable at any drug store) may be added 
to this in the proportion of one heaping teaspoonful to 
every four ounces of the mixture. If cane sugar is used 
a teaspoonful should be added to every six ounces. 

The Temperature of the Food should be 99 ° Fahr. 
It is a great mistake to make it too hot. The warming 
of the child's food should be accomplished by setting 



I9O OBSTETRIC NURSING. 

the filled nursing bottle into a vessel of hot water. It 
may be heated quickly over a gas jet by setting the 
bottle into a tin mug filled with water and holding it 
over the flame. Suggestions concerning the modifica- 
tion of food, when milk thus prepared does not agree 
with infants, will be given in another chapter. When 
the mother's supply of milk is scanty, and the baby cries 
with hunger, occasional meals of the above preparations 
will be a great aid in its management. 

In the artificial feeding of infants in the Woman's 
Hospital, sterilized milk is used for the various prepa- 
rations employed, as a rule. 

Sterilization of Milk. — By sterilizing milk is meant 
the process of destroying any poisonous matter which 
may have found its way into it. Exposure to the atmos- 
phere and admixture with particles of dust and dirt 
during its transportation, with want of care as to clean- 
liness of vessels, etc., in which the milk is kept, induce 
certain fermentative changes, which cause it to sour and 
to produce digestive disturbances. Sterilization destroys 
the germ of poisonous matter by subjecting the milk to 
a high degree of heat under pressure. Many forms of 
apparatus have been devised for this purpose. The one 
in use at the Woman's Hospital is called Blair's Steril- 
izing Apparatus.* It is very similar in general construc- 
tion to the one devised by Dr. Louis Starr and shown 

* Arnold's steam sterilizer has also been employed more recently with 
very satisfactory results. By this arrangement the milk is steamed instead 
of boiled. 



CARE OF THE NEW-BORN INFANT. 



I 9 I 



in the cut. This consists of an oblong case of tin fitted 
with a tight cover. Into this a movable wire basket, 
holding ten bottles, is placed. The bottles are of flint 
glass, graduated and fitted with rubber corks having a 




Fig. 32. — Sterilizer (Dr. Louis Starr).* 

glass plug fitted into an opening in their centers. The 
rules for using the sterilizing apparatus are as follows : — 

1st. Cleanse the bottles thoroughly. 

2d. Fill each with the milk you wish to use, put in 
the rubber cork without the glass plug (this leaves a 
small opening in the rubber cork); set the bottle in the 



* " Hygiene of the Nursery. " 



I92 OBSTETRIC NURSING. 

basket, then in the boiler; fill the boiler with water 
almost as high as the milk in the bottle ; boil about ten 
minutes, or, better, as Dr. Starr expresses it, " until the 
expansion that precedes boiling has taken place in the 
milk; " then put the glass plugs tightly in each stopper 
and boil for fifteen or twenty minutes more. Should the 
rubber corks incline to come out during the second boil- 
ing, put them in firmly. 

3d. Keep in a cool place till needed for use. 

4th. When to be used, place a bottle of the milk thus 
prepared in the tin mug which accompanies the appara- 
tus. Pour hot water in the mug until it is as high as the 
milk in the bottle. Heat the milk to the temperature 
desired for feeding (99 Fahr.) ; remove the rubber cork 
and put on rubber nipple, and feed. 

5th. Cleanse each bottle immediately after the milk in 
it is used. Do not keep milk in a bottle that has had 
some used out of it. 

6th. If the steaming process is preferred, place the 
basket, without the bottles, in the boiler, fill with water 
up to but not above the bottom of the basket, place the 
bottles in the basket and proceed as before. 

Milk should be sterilized as soon as possible after it 
has been served each morning. Each bottle, when 
emptied, should be thoroughly washed. If the whole 
contents of the bottle are not used after it is opened, the 
remainder must not be used for the child nor allowed to 
remain in the bottle. 

Milk sterilized in this way will keep for days without 



CARE OF THE NEW-BORN INFANT. 1 93 

spoiling, as it is hermetically sealed and has been de- 
prived of all unhealthy germs. Dr. Louis Starr makes 
the assertion that it will keep for eighteen days if the 
heating is continued for thirty minutes. 

Sterilized milk is useful wh^n traveling, as it may be 
carried without any trouble, the difficulty of obtaining 
fresh milk being thus overcome. Its use makes the 
management of babies during the heat of summer much 
easier. 

A word remains to be said concerning feeding-bottles 
and rubber nipples. 

The Nursing Bottle should be of clear glass, with a 
rounded bottom, of a shape convenient to clean, so that 
no particles may cling about corners which cannot be 
reached, serving as a source of trouble afterward. The 
graduated bottle is very nice, as it enables the quantity 
of each of the materials used in the preparation of the 
feeding to be mixed directly in the bottle, instead of being 
first measured out in a graduate. 

Feeding-bottles with India-rubber tubes are very ob- 
jectionable, for the tubes are difficult to keep clean, and 
a drop or two of milk left behind will often be sufficient 
to turn the next supply sour, causing the infant much 
sickness and suffering. Nurses are prone, also, with 
these tubes, to place the baby in its crib with the bottle 
of milk by its side and the nipple in its mouth. The 
heat of the child's body tends to sour the milk, the 
liquid may run low, and the child suck in considerable 
air. The neck of the bottle should always be kept filled 



194 



OBSTETRIC NURSING. 



with the liquid while the child is nursing, hence the 
position of the bottle must be changed. A feeding- 
bottle fitted with a rubber nipple requires to be held in 
the nurse's hand during the feeding, and is, on that 




Fig. 33. — Graduated Nursing Bottle (Dr. Louis Starr). 



account, to be preferred. There should always be two 
nursing-bottles for each baby, one being kept under 
water or filled with a soda solution while the other is in 
use. Immediately after the meal the bottle should be 
cleaned, etc. Scalding water should be used, and then 



CARE OF THE -NEW-BORN INFANT. 1 95 

the bottle filled or placed beneath a solution of bicar- 
bonate of sodium — ordinary baking soda — a teaspoonful 
to the pint, until it is again needed, when the soda solu- 
tion should be emptied out and the bottle thoroughly 
rinsed with cold water. Some use salicylate of sodium 
for the cleansing solution in preference to the bicar- 
bonate. 

Rubber Nipples. — Two nipples should be in use at 
the same time, being used alternately, and no nipple 
should be used longer than two weeks. A soft rubber 
nipple of conical shape is the best, because it can be 
more readily cleaned. The black rubber is generally 
softer than the white, and is to be preferred. The open- 
ing at the top of the nipple should not be too large, as 
that would permit the milk to flow through, when the 
suction produced by the child's mouth is necessary to 
the food being taken in a natural manner. So soon as 
the meal is over, the nipple should be removed from the 
bottle, brushed with a stiff brush, wet with 
cold water on the outside, then turned in- 
side out and similarly brushed on its inner 
surface. It should then be put in cold 
water and allowed to stand until wanted. 
A nurse's sense of smell should be keen 
enough to enable her to detect the slight- F ^.- 3 ^ e T^5 er 
est sourness about a bottle or nipple. 

The baby should be fed slowly — taking often ten to 
twenty minutes for its meal. Sucking from an empty 
bottle should never be permitted. 




I96 OBSTETRIC NURSING. 

It is a bad plan to make the whole'day's supply of 
food in the morning, unless the facilities for keeping it 
are such as to insure against its spoiling. When a 
sterilized preparation is used, it is desirable to have the 
whole amount prepared at once in a number of small 
flasks, each containing the amount for one feeding. 

The sterilization of the quantity of milk to be used 
during the day may all, however, be accomplished at 
one time. 

Home-made Sterilizer. — In lieu of the regular ster- 
ilizing apparatus, milk may be similarly boiled in a 
water-bath formed by any ordinary boiler, the milk being 
contained in a glass fruit-jar with a screw lid. After 
coming to the boiling-point, or boiling about two minutes 
without the lid, the latter may be screwed on and the 
boiling continued. A better way is to put the jar in a 
colander placed over a steaming tea-kettle in place of 
the lid. The milk should be allowed to boil in the open 
jar for about two minutes ; the jar lid then being screwed 
down, it should steam for twenty minutes. 

Fresh Air. — Besides good food and sufficient warmth, 
babies need an abundant supply of fresh air, hence the 
room should be kept pure and wholesome. 

In fine weather, after the first three or four weeks, a 
baby should be carried out in the open air every day 
for a time. 

It is preferable to carry the child in the arms, rather 
than to place it in a baby-coach. It can thus be kept 
warmer, and any evidence of chilling will be sooner 



CARE OF THE NEW-BORN INFANT. 1 97 

detected by the appearance of the baby's face. When it 
is not practicable to take the child out, the baby warmly 
wrapped may be carried about in a room, the windows 
of which have been raised, and free ventilation obtained. 



CHAPTER XIII. 

CHARACTERISTICS OF INFANCY IN HEALTH AND 

DISEASE. 

A healthy baby, if born at full term, should weigh 
3250 grams, or about seven pounds. Its length should 
be, on an average, 50 cm., or twenty inches. 

Development. — The head and trunk of the child are 
developed out of proportion to the limbs, so that the 
navel is below the middle of the child's body. This 
greater development of the upper part of the body is 
due to the fact that in the womb this portion of the 
child's body receives the greater amount of nourish- 
ment. The subsequent growth consists largely in the 
development of the lower limbs. 

The skin of a new-born baby varies in color from a 
pink to a decided red. The redness is more marked in 
premature babies. From the third to the fourth day 
this redness disappears, and the peculiar yellowish tinge, 
known as " baby jaundice," appears, as a result of the 
changes in the circulation. This is not true jaundice. 
This yellowish tinge of the skin should disappear by 
the end of the second week. At the same time that 
the skin begins to change color, from the third to the 

198 



FEATURES OF INFANCY IN HEALTH AND DISEASE. 1 99 

fourth day, it begins to scale or peel off. This is most 
noticeable about the fifth day, and lasts about sixteen 
days. 

The baby's limbs should be plump and well-rounded. 
The abdomen is prominent, as compared with the chest. 

The shape of the head varies very much. At times it 
is perfectly rounded, again it will be elongated and oval- 
shaped. 

Pressure during labor, either from the walls of the 
pelvis or as a result of the use of instruments, will cause 
at times considerable temporary distortion in the shape 
of the head. To allay swelling and prevent discolora- 
tion induced by bruising, fomentations may be used, 
either of simple hot water, or hot water containing a lit- 
tle fluid extract of hamamelis. Sometimes it is better to 
use cold applications, if the child is not too feeble. 

When there has been a good deal of pressure on the 
baby's head during the birth, the bones will sometimes 
override each other, and this will be shown by eleva- 
tions or ridges upon the baby's head, which soon dis- 
appear when the head is no longer subjected to pressure. 
These ridges, which are converted into soft grooves on 
the removal of pressure, indicate the separation between 
the different bones of the head, and are called "sutures." 
The larger soft places are called " fontanelles." The 
largest is on top of the head just above the forehead. 
It is called the " anterior fontanelle," commonly known 
as " the opening of the head." It is about large enough 
for the tips of two fingers to cover, when of normal 



200 OBSTETRIC NURSING. 

size, and is kite-shaped. A much smaller three-cornered 
fontanelle is found at the back of the head, and two be- 
hind the ears. These very soon fill up with bone. 

The large anterior opening does not close entirely 
until a child is about eighteen months of age. Should 
it remain open longer, it is a sign of constitutional 
weakness. In a healthy baby the surface of this fon- 
tanelle should be on a level with the surrounding bones 
of the skull. A slight pulsation may be noticed in it, 
due to the pulsation of the blood-vessels in the brain. 
Should the fontanelle be much depressed at any time, it 
would indicate a low state of vitality. Care should be 
taken not to permit any undue pressure on this part of 
the baby's head, as the brain here lies very near the 
surface. 

The fashion some old monthly nurses have of trying 
to shape the head by the pressure of the hands is dan- 
gerous, as the brain may be thus injured. As the head 
bones are soft, the child should not be allowed to lie 
too continuously on either side or on the back, as this 
will cause flattening of the part pressed upon. 

The first hair of the new-born baby, if it has any, is 
apt to fall out. The eyes of all new-born babies are of 
rather an indefinite color — a sort of blue. A change gen- 
erally occurs when the child is about two months old. 
At this time also vision is nearly perfect. A new-born 
baby probably cannot do more than distinguish light 
from darkness. Hearing and the sense of smell develop 
rapidly in a child. Loud noises waken it as early as 



FEATURES OF INFANCY IN HEALTH AND DISEASE. 201 

during the first week. By three months of age the 
child shows that it has a mind and is capable. of exer- 
cising thought. It grasps after objects and indicates by- 
its expression and gestures its likes and dislikes. By 
the age of eight or ten months it utters several syllables, 
and at the age of a year should be able to say " papa" 
and " mamma." By two years of age short sentences 
can be used. 

Weight of Baby. — For the first two days of a baby's 
life it loses weight, but by the third day it begins to 
gain, and by the end of the first week it should weigh 
what it did at birth. The average daily gain is 30 
grams, about 1 oz. The following facts concerning the 
early changes in weight are obtained from Gregory : — 

An infant born at full term weighs from 6 to 7 pounds, 
7 pounds being an average weight. For the first two or 
three days of life there is a loss of 4 ounces to 7 ounces 
then a regular gain, so that by the eighth to the ninth 
day the initial loss has been made good. The following 
figures express the average daily loss and gain during 
the first six days of life : — 

First day, Loss of 139 grams, or nearly 5 ounces. 

Second day, " 64 " " 2^ ounces. 

Third day, Gain of 33 " about I ounce. 

Fourth day, " 50 " " ity£ ounces. 

Fifth day, " 50 " " itf ounces. 

Sixth day, " 36 " " 1% ounces. 

The child's weight should be doubled in the fifth 
month, and trebled in the twelfth month. The baby 



202 OBSTETRIC NURSING. 

should be able to hold up its head in the sixteenth week, 
at the same time sitting up. It should stand by the 
thirty-eighth week. It should " take notice " and be 
able to grasp things by the third to the fourth month. 

It is important that a nurse should know the above 
facts as to the child's development, to be able to report 
satisfactorily concerning its condition to the physician 
in attendance. 

Sleep. — A large proportion of the time of early in- 
fancy is spent in sleep. The more premature the baby, 
the more constantly does it sleep. During sleep the 
eyelids should be tightly closed. A partial separation 
of the lids, showing the whites of the eyes, is an indica- 
tion either of some disease, or of pain, from whatever 
cause. 

The Respirations of a healthy baby when awake 
may be very irregular, some inspirations being shallow 
and others deep — at times hurried, and again slow. The 
only time when the respirations can be satisfactorily 
counted is when the child is asleep, for then the breath- 
ing is more regular. The rise and fall of the abdomen 
may then be noted (for the breathing of an infant is 
abdominal). The number of respirations in a minute 
average 44. So quiet is the healthy breathing of early 
infancy that there is no motion of the nostrils or of the 
lips, or even of the chest, to indicate the incoming and 
outgoing of air. Fever, colic, and lung trouble will 
greatly increase the number of respirations in a minute, 
making them mount up to 60 or 80, or even higher. 



FEATURES OF INFANCY IN HEALTH AND DISEASE. 203 

Nervous excitement has a similar effect, though this is 
temporary. 

In brain trouble, a slowing of the respirations occurs, 
so that they may get down to eight in a minute. When 
the act of breathing is painful a moan or cry accompanies 
each act of respiration. The expansion of the nostrils 
with each inspiration indicates a want of sufficient air 
space in the lungs. In connection with any lung trouble 
a bluish coloration of the lips and face generally is a bad 
symptom, as it indicates that sufficient air does not enter 
the lungs to purify the blood. 

The Pulse. — Little reliance is to be placed upon the 
pulse of a baby as indicative of disease, for it is characteris- 
tic of the infantile pulse that it is very rapid, very easily 
affected by external or internal causes, and notably 
irregular. The average pulse of the new-born baby is 
140. If a baby is well-nourished, it is too fat to enable 
the pulse in the radial artery to be counted. Hence 
the pulse is more easily obtained in the temple or at the 
ankle. If not thus readily obtained, the heart beats 
may be counted by holding the hand over the baby's 
heart. 

The Temperature of a child at this age is also 
subject to rapid changes, the result of slight causes. 
The average temperature is 99 ° Fahr., but a cold or an 
attack of indigestion may cause a sudden increase, with 
as sudden a return to normal when the cause is removed. 

A sub-normal temperature is an indication of lowered 
vitality, the result of some drain upon the system, as of 



204 OBSTETRIC NURSING. 

an exhaustive diarrhea, or of some constitutional weak- 
ness. This fall of temperature is a dangerous symptom 
in infants. The tip of the nose and the extremities of 
the child, if cold, also indicate a condition of low vitality, 
and require that the child should receive very especial 
care from the nurse as to the supply of food and warmth. 
In fever the back of a child's head feels very hot, as 
also do the palms of the hands. 

The Cries of a Child form a special language by 
which its needs may be made known. Every nurse 
should learn to distinguish the peculiarity in the differ- 
ent kinds of cries, so as to meet the varying demands 
thus indicated. A healthy, well-trained baby rarely 
cries, unless hungry, when the cry will be constant and 
very persistent until the want is satisfied ; the upper part 
of the body is moved at the same time, especially the 
arms and head. The cry induced by ear-ache is also 
unappeasable, and generally accompanied by a drawing 
of the hand up to the head. A similar gesture accom- 
panies the cry induced by brain trouble, which is a shrill 
scream, often waking the child during sleep. 

A cry accompanying a cough is an indication of pain in 
the chest. The paroxysmal character of colic is indicated 
by the characteristic cry which accompanies it — a sharp, 
sudden cry — the limbs at the same time being drawn up 
toward the abdomen. An evacuation of the bowels may 
precede or follow the cry. 

Sore Mouth. — If, in nursing, a baby seizes the nipple 
by the mouth and drops it suddenly with a cry, doing 



FEATURES OF INFANCY IN HEALTH AND DISEASE. 205 

this repeatedly, there is in all probability some soreness 
of the mouth, which should be discovered, and treated. 
However heartrending the cry, the baby does not se- 
crete tears in sufficient quantity to run down the cheeks, 
until the third month of infancy. Hence the common 
saying, that a baby cannot suffer pain because it sheds 
no tears while crying, is not supported by fact. 

Facial Expression. — A wrinkling of the forehead 
vertically, produced by drawing the eyebrows together, 
indicates pain about the head. A sharpening or play 
of the nostrils exists in lung troubles. A drawn look 
about the mouth is found with digestive troubles, as 
flatulent colic. 

The Stools of a very young baby fed on breast milk 
should be of a yellow or orange color. Three or four 
evacuations a day are natural. They should contain 
no curds. Stools of bottle-fed babies are lighter and 
more offensive. 

Urination. — The number of times a new-born baby 
urinates will vary much with the weather and the condi- 
tions under which the child is placed. It is not unusual 
in cold weather for the napkin to need changing almost 
every hour. Healthy urine should not stain the napkin. 

Mothers and nurses are often much troubled by the 
failure of an infant to pass urine or feces for the first 
few hours or days of its life. A careful examination 
of the anus or external opening of the bowel will soon 
show whether there is any imperforate condition of the 
rectum, which may cause the retention of feces. Clos- 



206 OBSTETRIC NURSING. 

ure of the urethra is so rare that retention of urine is 
very seldom seen. 

The new-born infant secretes but very little urine 
until it begins to take nourishment freely. The bladder 
is usually emptied during the process of birth, as also is 
very frequently the case with the bowels, so that if the 
child seems well and there is no malformation of the 
parts, the family may be assured that the condition is 
only temporary. 

The use of fomentations over the kidneys and bladder 
will frequently hasten the evacuation of urine if it be 
unduly delayed. If the secretion seems highly concen- 
trated, as is shown by the brickdust deposit sometimes 
found on the baby's diaper, a drop of sweet spirits of 
nitre in a teaspoonful of water may be given once in 
two hours. 

Should the child seem to suffer pain from the reten- 
tion of the contents of the bowel, an ounce of warm 
water or olive oil injected into the rectum will usually 
produce a satisfactory evacuation. Should a laxative 
by the mouth be needed, the physician must be con- 
sulted. A teaspoonful of sweet oil often serves the 
purpose very nicely, or a few grains of manna dissolved 
in milk. 

The Teeth sometimes appear prematurely. A child 
maybe born with one or more teeth already cut. These 
are usually imperfect, and fall out in a short time, to be 
replaced by the milk-teeth. The latter are twenty 
in number and are usually cut in groups, starting 



FEATURES OF INFANCY IN HEALTH AND DISEASE. 207 

about the fourth month and continuing till between the 
twentieth and thirtieth months, when the first dentition 
should be complete. Girls are more apt to cut their 
teeth early than boys ; and, as an early dentition is 
usually an easy one, it is fortunate for the child to have 
it occur early. 

Even under normal conditions the edges of the gums 
in teething become swollen, rounded, and reddened, as 
the teeth come near the surface. The saliva is at the 
same time increased .in quantity, and the mouth is 
heated and uncomfortable, so that the child desires con- 
stantly to bite upon any object that may be at hand. 
A healthy child should not suffer in any way from the 
process of dentition, and when the point of the tooth 
comes through the gum the local symptoms may vanish. 
These are cut in groups, there being an interval of rest 
between the eruption of each group. 

The following diagram will illustrate the order in 
which the teeth are cut. The numbers I to 5 show to 
how many groups the several teeth belong and the 
order in which the groups appear. The letters a and 
b show the order in which the teeth in each group 
appear. 

Bottle-fed babies are more apt to be late cutting their 
teeth than those that are breast-fed. If no teeth have 
appeared when the child is a year old, we may know 
that the child's general nutrition is at fault, or it may 
have the disease known as rickets. 

Bottle-fed babies are also apt to have their teeth come 



208 



OBSTETRIC NURSING. 



through the gum in irregular order. This frequently is 
an indication of lack of health, although sometimes it is 
a family peculiarity. 

The first set of teeth which the child has is called the 
temporary set. It consists of twenty teeth, known as 
milk teeth. The permanent set, of which the first appear 




Fig* 35. — Diagram Showing Eruption of Milk Teeth.* 

1, 1. Between the fourth and seventh months. Pause of three to nine weeks. 2, 2, 2, 2. 
Between the eighth and tenth months. Pause of six to twelve weeks. 3, 3, 3, 3, 3, 

3. Between the twelfth and fifteenth months. Pause until the eighteenth month. 

4, 4, 4, 4. Between the eighteenth and twenty-fourth months. Pause of two to three 
months. 5, 5, 5, 5. Between the twentieth and thirtieth months. 

at about six years of age, consists of thirty-two teeth. 
They push upward in the jaw and loosen the first set, 
gradually displacing them. 

Walking. — Many children creep before they walk, 



* From Starr, " Diseases of the Digestive Organs in Infancy and 
Childhood." 



FEATURES OF INFANCY IN HEALTH AND DISEASE. 20g 

and in that case may prefer this means of locomotion to 
walking. A child usually creeps as early as seven or 
eight months. At about ten months the child may walk 
by holding on to things. Strong children may walk 
alone at one year of age. With weaker children this 
may be delayed until two years. 



H 



CHAPTER XIV. 
THE AILMENTS OF EARLY INFANCY. 

It is not proposed in this chapter to take up all the 
ailments of infancy, for the term infancy comprises a 
time beginning with the birth of the child and lasting 
until the first dentition. 

The obstetric nurse remains with the patient from four 
to six or eight weeks. During this time many devia- 
tions from the normal, healthy state may be met with in 
the child, and these she should be quick to observe and 
know how to manage. 

Prematurity. — One of the most important conditions 
of this period is " prematurity," a result of the too early 
birth of the child. 

A premature birth is one that occurs at any time after 
the child is " viable," that is, capable of living after its 
birth. The term of viability has been set at twenty-eight 
weeks, or seven lunar months. Deliveries occurring 
previous to this time are called " miscarriages." 

It may be that, with improved methods of manage- 
ment, the period of viability may be placed at an earlier 
date, but this is as yet a matter for proof.* 

*The French claim that by means of gavage and the couveuse, or 
hatching-cradle, the actual period of viability has approached six months 
of intrauterine life. 

210 



THE AILMENTS OF EARLY INFANCY. 211 

It has generally been conceded that a child t>orn 
at six lunar months cannot live, that at seven months it 
stands little chance, that at eight months its chances are 
better, and at nine still better. 

The popular notion that an eight-month baby (count- 
ing the calendar months) does not stand as good a 
chance of living as a seven-month baby is altogether 
wrong. Great care is needed for premature babies. 
They especially need regular feeding and to be kept 
very warm. The skin, being thin and delicate, will also 
require very careful attention. 

Until within a few years the matter of keeping the 
baby sufficiently warm was exceedingly difficult to man- 
age. The French invention of the " couveuse," or 
" brooder," has simplified the matter very much. It was 
first used in some of the French lying-in hospitals in 1 88 1 . 
Since then it has come into quite general use in France, 
being employed even in private houses. Many different 
forms of the apparatus now exist. The one most com- 
monly used in France is Tarnier's invention. This has 
been used for some time with great satisfaction in the 
Woman's Hospital, of Philadelphia. 

It consists of a wooden box, whose interior is divided 
into an upper and lower compartment. There is a space 
about four inches wide at one end of the upper com- 
partment which communicates with the floor below. 
Here two or three large sponges on a wire stem are 
placed. The lid of the box at the opposite end contains 
a chimney, in which a helix rests on a pivot. 



212 



OBSTETRIC NURSING. 



The upper compartment of the box is intended for the 
baby ; in the lower end are several stone jars, which are 
to be kept filled with very hot water. At the end of the 
box furthest away from the open space which com- 
municates with the chamber above, a register is fixed, 
which may be opened or closed at will. The air enters 
through the register, is heated by passing over the hot 
stone jars, moistened by the wet sponges in the space 




Fig. 36. — Tarnier's Couveuse. 



between the upper and lower chambers, and finds its exit 
from the chimney, in which it keeps the little wheel 
revolving. The motion of this wheel indicates whether 
the circulation of air within the couveuse is perfect or 
not. A thermometer fastened to one side of the interior 
of the box assists in the regulation of the temperature, 
which should be kept at from 85 to 95 Fahr., according 
to the indications in each case. A frame containing a pane 
of glass forms the top of the box. Through this the 



THE AILMENTS OF EARLY INFANCY. 213 

record of the temperature and the condition of the child 
can be watched.* 

The following directions for the use of the couveuse 
are given by Dr. Auvard, who superintended its intro- 
duction into the Maternite, at Paris : — 

To keep up an even temperature, one of the stone jars 
should be refilled every hour, hour and a half, or two 
hours. 

The apparatus being more difficult to heat when it 
stands in a draught of air, it should be placed so as 
to avoid this. 

Should the temperature rise too high, the cover may 
be slipped down a little, so as to allow of the entrance 
of air from above, or the inferior register may be opened 
so as to admit a larger quantity of air. The partial 
closure of the register so as to admit less air would help 
to raise the temperature when it tends to fall below the 
desired point, as also would the addition of hotter water 
to the jars. 

The child should be placed in the upper compartment 
of the couveuse as in its cradle, being removed simply 
for nursing, its bath, and toilette. When removed from 
the couveuse, care should be taken to have the tempera- 
ture of the room sufficiently warm. Auvard sets this 
temperature at 61.2 . We should be inclined to require 
a higher temperature, as from 70° to 75 ° Fahr. 

* Dimensions of couveuse for a single infant : Width, 36 centimeters ; 
length, 65 centimeters ; height, 55 centimeters. For twins a larger case is 
necessary, which holds a correspondingly greater amount of hot water. 



214 OBSTETRIC NURSING. 

The length of time the child remains in a couveuse 
will vary from fifteen days to three weeks, a month, or 
even more. It should not be removed permanently until 
it has acquired sufficient vigor to live in the ordinary 
atmosphere of the apartment. To accustom the child 
to this atmosphere, it should, as it grows stronger, be 
removed for an hour at a time from the couveuse during 
the warmest part of the day. 

It is best to continue the use of the apparatus at night 
for some time after the child becomes accustomed by 
day to removal from the couveuse, for the danger of 
chilling from changes in the atmosphere is greater at 
night. 

Auvard recommends the use of the couveuse in all 
cases where the vitality of the child is enfeebled either 
by external causes, as cold, or internal causes, as prema- 
turity, congenital feebleness, cyanosis, or " blue disease," 
wasting, or other general maladies enfeebling to the new- 
born. 

To overcome the difficulty in the management of this 
couveuse, owing to the necessity for the frequent re- 
moval of the hot water jars, Auvard has devised an 
improvement, which is shown in Figs. 37 and 38. 

A cylindrical reservoir of metal takes the place of the 
hot-water jars in the lower compartment of the couveuse. 
This reservoir is filled by means of a metallic funnel 
fastened to one end of the box and communicating with 
the cylinder through a metallic tube. 

The overflow of the cylinder is provided for by a 



THE AILMENTS OF EARLY INFANCY. 



215 



curved metallic tube at the lower part of the cylinder 
beneath the inlet through which the reservoir is filled. 

The air enters by a register on one side of the couveuse 
instead of at the end, as in Tarnier's apparatus. The 
other portions of the apparatus are the same as Tarnier's. 

The metallic cylinder is capable of holding ten liters 




Fig. 37.— Auvard's Couveuse (Interior View).* 



of liquid (a liter is a little over a quart). To start the 
apparatus, about five liters of boiling water should be 
poured in, after which three liters may be poured in 
every four hours. When ten liters are. contained in the 
cylinder, the overflow-pipe carries off the excess. Auvard 
suggests having two vessels, capable of holding three 



* Archives de Tocologie, 



2l6 OBSTETRIC NURSING. 

liters each, keeping one under the escape-pipe and 
the other over the fire, reheating the water in the 
vessel filled by the escape-pipe and having it in 
readiness for the next change. The two vessels may 
be thus used alternately, and but little time con- 
sumed in the heating of the apparatus as compared 
with that required in the use of Tarnier's invention. 



Fig. 38. — Auvard's Couveuse (Exterior View). 

To empty the cylinder, a rubber tube is attached to 
the escape-pipes, by which it is made to act as a siphon 
— a small quantity of water poured into the cylinder 
through the funnel being sufficient to start the liquid. 

Before the couveuse was known premature babies were 
swaddled in cotton, in order to be kept sufficiently warm. 
The directions for doing this are as follows : — 



THE AILMENTS OF EARLY INFANCY 



217 



Take a square baby-blanket and place it diagonally 
on the table or bed. Turn down one corner for four 
inches distance, to come up over the baby's head. Spread 
over this blanket a lap of raw cotton. Have the baby's 
napkin and binder on, and a flannel undervest. Make a 
cap out of the cotton, fitting it over the baby's head and 
bringing it down well under the chin. Then roll the 
baby up in the cotton lap. Bring the blanket around this 
firmly, so as to hold it ; the portion of the blanket on 




Fig. 39. — Swaddled Baby. 



the baby's right being brought over and tucked in on 
the left side, the portion on the left being correspond- 
ingly folded over toward the right. The corner of the 
blanket left at the feet is then folded up over the front, 
and the whole held in place by means of a strip of 
muslin bandage or ribbon. The bandage is first applied 
beneath the chin, crossed under the back, again crossed 
in front, the ends being brought forward to fasten in a 
bow-knot at the feet. 

The great disadvantages of this method may be seen 
in the restriction it gives to the movements of the -child's 



2l8 OBSTETRIC NURSING. 

limbs, and the difficulty of determining when the child's 
napkin needs changing, also the frequent exposure of the 
child during these changes to the ordinary atmosphere. 

An ingenious method of maintaining the body-heat of 
a baby, and one readily accomplished in any household, 
is described as follows by Dr. Reynolds : — 

"A large basket should be thickly lined with heated 
blankets or other flannels. A number of bottles, filled 
with very hot water, should be so arranged around the 
sides of the receptacle that they can be removed and re- 
inserted without disturbance of the infant. The child is 
wholly covered, with the exception of its face, with well- 
warmed cotton batting, and is laid between the bottles ; 
and the cradle is then covered with a thick blanket, a space 
at the end which corresponds to the child's head being left 
open to permit the entrance of air. A thermometer should 
be laid beside the child, and one or more of the bottles 
should be refilled with hot water whenever the tempera- 
ture is seen to fall below 87 F. The water should not, 
on the other hand, be so hot as to raise the temperature 
of the contained air much above 90 F." 

If the baby be very weak, it may be necessary to 
stimulate it for two or three days by giving it a drop or 
two of brandy, with or without a drop of aromatic spirit 
of ammonia, in a teaspoonful of warm water once in two 
hours. 

The length of time a premature baby should be kept 
in its close quarters is dependent upon the progress it 
makes ? «or until the gain in weight and strength brings it 



THE AILMENTS OF EARLY INFANCY. 219 

up, as nearly as possible, to the standard of a baby at 
Full term. A seven-months child, if strong enough, may 
be dressed when it is four weeks old, and allowed to 
nurse. Great care, however, must continue to be exer- 
cised until the child reaches full term. 

The skin of a premature baby should be well greased 
after every bath, or some oil, as cotton or sweet oil, may 
be used, and will serve the double purpose of protecting 
the skin and giving nourishment by absorption. 

The child should be fed every hour. As it is usually 
too weak to suck, it is safer to feed the baby with a spoon 
or with a" dropper, to make sure of its obtaining a suffi- 
cient amount of food. From one to two teaspoonfuls 
should be given every hour. Breast milk is, of course, 
the best. It may be drawn from the mother's breast and 
fed to the child while warm. The nurse should intro- 
duce her little finger into the child's mouth and allow 
the milk to trickle slowly down the finger, so as to enter 
the mouth drop by drop, while the child sucks the finger. 
Should the mother have no milk, the first week's feeding 
recommended by Dr. Starr, or sterilized peptonized milk, 
diluted two-thirds with boiled and filtered water, should 
be used — if no wet-nurse can be had as a substitute. 

Gavage. — Should the baby drink badly and throw up 
a large proportion of the liquid given. to it, " gavage " 
may have to be resorted to. The physician must 
authorize the nurse to carry this out, for she should 
never undertake it otherwise. The directions for prac- 



220 OBSTETRIC NURSING. 

ticing gavage, as given by Dr. Louis Starr, are as 
follows : — 

The apparatus used is quite simple, being nothing 
more than a urethral catheter of red rubber (No. 14-16, 
French), at the open end of which a small glass funnel 
is adjusted. The infant upon whom gavage is to be 
practiced is placed on the knee, with its head slightly- 
raised ; the catheter, being wet, is introduced as far as 
the base of the tongue, whence, by the instinctive efforts 
at swallowing, it is carried as far down as the esophagus 
(or gullet) and into the stomach. 

The liquid food is next poured into the funnel, and by 
its weight soon finds its way into the stomach. After a 
few seconds the catheter must be removed, and here is 
the great point in the operation ; it must be removed 
with a rapid motion and at once, for if it be withdrawn 
slowly all the food introduced will be vomited. 

Mothers' milk is the best for gavage, as at any time, 
but other kinds of food may be used. The amount given 
and the number^ of meals will vary with the age and 
strength of the child. From a teaspoonful to a dessert- 
spoonful at one time is sufficient for a very young child, 
given every hour. Too much food would produce indi- 
gestion. As the child grows stronger this mode of feed- 
ing may be made to alternate with nursing. Diluted 
sterilized milk peptonized may be used for the alternate 
feedings. 

Colic is a very troublesome affection of infancy. It 



THE AILMENTS OF EARLY INFANCY. 221 

corresponds to the dyspepsia of grown people, and indi- 
cates that the food is either improper in quality or quan- 
tity. A colicky cry is a sudden, sharp cry, the baby 
drawing up its feet and legs at the same time. The feet 
are generally cold, and one indication for treatment is to 
warm them ; warm socks or woolen stockings should be 
worn, or hot bottles applied to them. 

The abdomen should also be kept warm by the appli- 
cation of heated flannels, or a spice poultice, wrung out 
in hot whiskey, or a flaxseed poultice, and kept applied 
until the baby gets relief. 

To make a spice plaster, a teaspoonful each of ground 
allspice, cloves, cinnamon, ginger, and cayenne pepper, 
with four teaspoonfuls of flaxseed meal, may be quilted 
into a bag of flannel, 4x8 inches, which will fit entirely 
over the baby's abdomen. When the spicy smell is lost 
the plaster is no longer good for use. 

Warm oil rubbed gently in over the abdomen for ten 
to fifteen minutes at a time, will often give relief by lead- 
ing to the expulsion of the wind causing the pain. 

If the application of heat is not sufficient, anise-seed 
tea should be given. It is made as follows : — 

Over a half-teaspoonful of anise-seed pour a half- 
teacupful of boiling water. Allow it to steep a few 
minutes, until the water tastes strongly of the anise- 
seed. A half-teaspoonful of this may be given warm 
every ten minutes until the baby has had four doses. 
This brings up wind from the stomach, and thus gives 
relief. Simple hot water will help in the same way 



222 OBSTETRIC NURSING. 

should anise-seed not be on hand. Catnip tea may 
be made and used according to the same directions. 
These teas are preferred to the drop doses of gin so 
frequently given. 

Bowel Movements. — Frequent stools do not always 
indicate diarrhea. For the first six weeks of its life a 
child averages three or four movements every twenty- 
four hours, after which it has about two a day until it is 
two years old. 

A natural passage for an infant would be of a mushy 
consistency and a yellow or orange color. It should 
contain no curds. Bottle-fed babies have whiter and 
more offensive stools than breast-fed babies. 

Diarrhea. — In diarrhea there is a change in consist- 
ence or appearance. A liquid stool, or one colored 
green or white or like putty would be abnormal. The 
presence of curds also would show an inability to digest 
the food properly. The diarrheas of infancy, though 
oftenest due to improper food, may be caused by ex- 
posure to heat, or may result from taking cold. Bottle- 
fed babies suffer much with diarrhea in summer time, 
indigestion and heat acting together to produce the dis- 
ease. Often little can be accomplished without entire 
change of air. A trip to the seashore or the mountains 
has saved many a baby's life. 

In simple diarrhea there is little, sometimes no fever. 
There may or may not be vomiting. In cholera infantum 
the stools are very numerous, the discharges being the 
color of rice-water. There is constant vomiting, high 



tHE AILMENTS OF EARLY INFANCY. 223 

fever, intense thirst, great coldness of the surface, and 
often sudden collapse. 

In inflammation of the bowels the movements are smaller 
and have some color. The fever is more moderate and 
the vomiting is less. 

In dysentery the passages are frequent, small, and con- 
tain more mucus. There is much straining and often 
quite a large amount of blood passed. The emaciation 
of infants with these diseases is very rapid. 

The careful regulation of the baby's diet is the most 
important consideration in treatment. At first all food 
must be stopped for five or six hours. A little barley- 
water or egg-albumen water, or some simple meat juice 
may be used if the baby seems hungry. Cold water 
also may be given. If the baby's skin feels hot it may 
be bathed or sponged with cool water frequently. If 
the surface is cold a tepid mustard bath may be given. 
When the attack first begins it is well to clear the bowel 
of all irritating substances by a dose of sweet oil, to 
which (for an infant under two months) 15 drops of castor 
oil may be added. After this a little bismuth and chalk 
mixture is usually given by the physician, or small pow- 
ders containing bismuth (about 1 gr.), once in two or 
three hours. The physicians will usually determine the 
special remedy indicated after careful inspection of the 
stools. 

Feeding in Indigestion. — If, therefore, curds exist in 
the stools, or the matters vomited be curdy, the indica- 
tion would be to use some alkali or a small quantity of 



224 OBSTETRIC NURSING. 

some thickening substance, as barley-water, gelatin, or 
one of the prepared foods intended to serve the same 
purpose, or the milk may be peptonized. 

Lime-water is the alkali most usually employed. Lime- 
water contains but about half a grain of lime to the fluid- 
ounce of water, so that at least a third of the feeding 
should be lime-water where it is used to correct indiges- 
tion. To make lime-water, a piece of lime about the size 
of the fist should be placed in an earthen vessel; about 
three or four quarts of water may be poured over this, 
strained thoroughly, and then allowed to settle. The 
water should be used only from the top of the vessel. 
It is better to filter it before use. The vessel may be 
kept filled with water so long as any of the lime remains 
in it, when it will be necessary to add more lime. 

When lime-water cannot be obtained, a small powder 
of baking soda — three or four grains — may be added to 
the nursing-bottle. These rules apply when the baby is 
artificially fed. Should the baby be nursing the breast a 
teaspoonful of lime-water mixed with an equal quantity 
of boiled and filtered water may be given it before each 
time it is put to the breast. 

Barley-Watei;. — Of the thickening substances used 
to help in the digestion of food, barley-water is one of 
the best. To make barley-water, a gill of boiling water 
should be poured over a teaspoonful of washed pearl 
barley, freely ground in a coffee-mill. Boil for a quarter 
of an hour, then strain. It should be mixed with milk 
in the proportions required, two-thirds, a half, or one- 



THE AILMENTS OF EARLY INFANCY. 225 

third. A pinch of salt should be added to the mixture. 
Oatmeal-water is similarly made. 

Gelatin is sometimes used instead of barley-water. 
A piece an inch square of plate gelatin is put into a half 
tumblerful of cold water and allowed to stand about 
three hours. This may then be turned into a teacup and 
set in a pan of hot water and boiled. The gelatin thus 
dissolves, and when allow r ed to cool, forms a jelly, of 
which one or two teaspoonfuls may be added to a feeding.. 

Infants' Foods. — Of the various kinds of " infants' 
food," those in which the starch has JDeen made into 
dextrine or grape sugar are the best. " Mellin's Food " 
and " Horlick's Food" belong to this class. A tea- 
spoonful of these dissolved in a little hot water — about a 
tablespoonful — may be added to the milk for the feeding. 
These starch foods cannot be well borne by a child 
before it is five or six months old, as a rule, because the 
secretion of saliva is necessary to the digestion of starch.* 

Condensed Milk contains a large proportion of sugar, 
hence tends to make fat. It is not as nourishing as 
many other forms of food. Babies fed on it, though 
large, are generally far from strong, and are very apt to 
suffer from indigestion. 

A careful regulation of the diet for the early weeks of 
infancy, with the addition of barley-water, lime-water, or 

* The prepared foods are not to be especially recommended, notwith- 
standing their efficacy in certain cases. Made by the quantity — their com- 
position is of necessity often uncertain, and they must frequently be stale as 
obtained for use. 
15 



226 OBSTETRIC NURSING. 

gelatin, as indicated, in place of plain water, has been 
found most satisfactory in the care of infants in the 
Woman's Hospital. The use of water alone as a diluent 
is preferred. When curds are persistently found in the 
stools, it is sometimes of advantage to slightly thicken 
the milk by the addition of a little prepared wheat flour, 
barley, oatmeal, or Graham flour. 

Flour Ball. — In using wheat the following recipe 
may be employed : [Tie a pint of dry wheat flour into a 
piece of stout muslin and boil nine hours; scrape off the 
outer crust and -the inside will be found to be a dry ball ; 
grate this as needed and add about two teaspoonfuls to 
a pint of water, which when boiled may be used in dilut- 
ing the child's milk in the proportion desired, instead of 
using plain water.] After the sixth month, four tea- 
spoonfuls may be used in place of two. Dr. J. Lewis 
Smith recommends allowing the flour, tightly tied up 
in a bag, to stand under water for about a week, the 
water being allowed occasionally to boil during this time. 
The flour is thus rendered more digestible. 

Other Cereals. — Ground barley, oatmeal, or Graham 
flour may be boiled in water in the proportion of a des- 
sertspoonful to the pint. An equal quantity of milk 
may be poured in while the water is boiling, and the 
whole may be boiled together from about twenty minutes 
to a half-hour and then strained. A pinch of salt should 
always be added. An ounce of cream and a little milk 
sugar may be added to this. Dr. Keating recommends 
this preparation as excellent for an infant after its fourth 



THE AILMENTS OF EARLY INFANCY. 227 

month, when he considers that it is best to make 
the use of the bottle alternate with the breast in the 
feeding of an infant, especially if the mother is not very 
strong. 

Weaning. — If the mother has substituted the bottle 
for some of the feedings as early as at the age of six 
months, the child will not suffer from the process of 
weaning. In fact, a child often weans itself, refusing to 
take the breast milk during the later months. The 
mother's milk, even in most favorable cases, is rarely 
sufficient nourishment for the child after it is a. year old. 
If possible, no change in the child's food should be 
made in the summer months. 

Substitutes for Milk. — When the child is very weak 
and vomits constantly — milk, especially, seeming to dis- 
agree with it — some of the following measures may be 
resorted to : small and repeated quantities of barley- 
water, gum-arabic water, or wine-whey may be used, a 
teaspoonful every half-hour or hour ; sometimes the 
white of an egg may be shaken up in a bottle of warm 
water and a couple of grains of lactopeptin or Fairchild's 
liquor pancreaticus may be added, with a little milk 
sugar, and this may be given the child in teaspoonful 
doses. As the child's stomach grows stronger, tea- 
spoonful doses of peptonized milk may be tolerated. No 
child should be fed too continuously on the prepared 
foods alone. Fresh milk should be used whenever possi- 
ble, as a disease known as scurvy often arises from long 



228 OBSTETRIC NURSING. 

use of stale preparations. The admixture of cream 
with milk (i part to 5 or 6 of water) has already 
been referred to as a substitute when milk is not well 
borne. 

An occasional drink of water is essential to a baby, 
however young. The water should be boiled and kept 
air-tight to be free from germs. From a teaspoonful 
to a tablespoonful may be given occasionally during 
the intervals of nursing. Infants under four months 
of age should be fed upon milk alone in some of its 
forms. 

Milk Foods. — When breast milk cannot be had and 
cows' milk seems persistently to disagree, some of the 
" milk-foods," as Carnrick's Soluble Food, Anglo-Swiss, 
Gerber's, or American Swiss, should be tried first before 
any preparation containing starch is used. Care must 
be taken to see that the preparations are fresh before 
using. 

The Farinaceous Foods, as Blair's Wheat, Hubbell's 
Wheat, Imperial Granum, and the home-made prepara- 
tions before described, should not be used until the child 
is at least four months old. 

Liebig Foods. — If in the use of the latter the child's 
bowels become constipated or it suffers from colic or is 
restless at night and loses its appetite, some of the 
Liebig foods may be tried, as Mellin's, Malted Milk, 
Lactated Food, etc. The directions for the use of these 
foods come with the various packages containing them 



THE AILMENTS OF EARLY INFANCY. 229 

and are readily followed. Milk, as a rule, in some form 
or other, should be used in making up these prepara- 
tions, otherwise they will not contain sufficient nourish- 
ment. 

Constipation is not an infrequent occurrence in in- 
fancy. Its management consists principally in the use 
of mechanical irritants for stimulating the bowels ; thus, 
a soap suppository, an injection of warm oil or water, 
gentle friction over the bowel, especially following the 
direction of the large bowel from right to left, are 
among the most effective methods for overcoming this 
condition. 

The soap suppository is made by taking a piece of 
Castile soap, about one inch long, and shaping it into a 
cone and making it very smooth, so that it will not be 
larger around than the end of the little finger. This 
should be gently insinuated about half its length into 
the bowel and held in the opening until it excites the 
bowel to act. 

The bowel injection may be given by means of the 
single-bulb syringe, known as the " eye and ear syringe." 
The bulb holds about two tablespoonfuls of liquid. This 
may be warm cotton-seed oil, sweet oil, or warm water. 
The nozzle used should be small, smooth, and well oiled. 
It should be very carefully introduced into the bowel, 
being directed a little to the left side, and the bulb gently 
squeezed to force the contents into the bowel. It is best 
that the liquid should be retained for a little time before 
it is forced out. The keeping up of a slight pressure 



230 



OBSTETRIC NURSING. 



over the entrance to the bowel for a short time will 
aid this. 

Rubbing the abdomen for about ten minutes (either 
with or without oil) in the direction of the large bowel — 
that is, upward on the right side as far as the border of 
the ribs, then across to the left side 
and down this side to the pelvis, is 
often efficient in overcoming constipa- 
tion. 

Of medicinal measures , glycerin, glu- 
ten, or cacao-butter suppositories may 
be resorted to, or manna may be given, 
a piece the size of a pea in the child's 
milk one, two, or three times a day, or 
a spoonful of water sweetened with 
dark-brown sugar. Should the child 
be on artificial food, oatmeal water 
may be substituted for barley-water 
in the preparation of the food. If 
nursing, oatmeal water may be given it 
(i tablespoonful) before each nursing. 
Rupture, or Hernia, is a protrusion of the bowel 
through some weak point in the abdominal walls. It 
very often occurs at the navel and sometimes in the 
groin. A button mold can be fastened over the navel 
to keep in the protrusion, being held in place by a 
strip of adhesive plaster. A truss will need to be fitted 
for the other form. 

Vomiting. — Babies vomit very easily, because their 




Fig. 40. — Single-bulb 
Syringe (Starr). 



THE AILMENTS OF EARLY INFANCY. 23 1 

stomachs are placed more vertically in the body than 
when they grow older, and over-feeding will cause them 
to bring up the amount in excess of what the stomach 
can hold. This vomiting is, of course, not serious. 
Should the vomited matter be sour and curdy, the child 
seem to suffer from nausea, weakness, or fever, it in- 
dicates a condition of indigestion which should receive 
attention. The management would largely consist in 
the regulation of the quality and the quantity of the food, 
as has just been said. It is best to withhold food for 
several hours, and modify its character when it is re- 
sumed, as described above. A spice-plaster over the 
stomach is often helpful. When the vomiting is due to 
over-eating, the amount of food taken at one time must 
be regulated. 

Worms. — There are three different kinds of worms 
which may exist in children, but young infants are not 
troubled, as a rule, with but one kind, the thread or seat- 
worm. These look like little pieces of white cotton 
thread, and the stools should be carefully examined 
when suspected. They make the parts around the lower 
bowel very sore and produce intense itching. The parts 
should be kept very carefully cleansed, and a bowel in- 
jection of salt and water, or a little infusion of quassia 
may be given every day or so. 

The tape-worm and round worm are found with older 
children. 

Thrush is a disease due to want of care of the baby's 
mouth. If milk be allowed to collect on the tongue, it 



232 OBSTETRIC NURSING. 

sours, and the presence of this acid favors the develop- 
ment of thrush, which is really a vegetable parasite. 
White patches may be seen on the soft palate, inside the 
cheeks, lips, and tongue. The attempt to rub off these 
patches causes bleeding. Gastric catarrh and diarrhea 
usually accompany this trouble. Care in cleansing the 
child's mouth after each nursing will prevent the occur- 
rence of thrush. Its treatment consists in the use of an 
alkaline wash, as borax and water (twenty grains to the 
ounce), or some antiseptic wash prescribed by the phy- 
sician.* 

Birth Marks, that is, the purplish-red patches, or 
the moles sometimes found on a new-born baby, are not 
dependent in any way on the mental impressions of the 
mother. They can often be removed by treatment. 

Red Gum is an eruption which comes out over the 
baby in the first or second week of its life. Sometimes 
these little points of elevation on the skin are white. The 
eruption is then called " white gum." These eruptions 
are due to changes in the skin and irritation from ex- 
posure to air, and are not serious. They rarely last over 
a week, although they may persist for several weeks in 
babies of delicate skin or poor digestive powers. They 
are also known as strophulus. 



* Boric acid (ten grains to the ounce of water) is very good. A tea- 
spoonful of this may be swallowed by the child occasionally. Of late a so- 
lution one part hydrogen dioxide to eight of water has been much used. 
This followed by the boric acid wash. After which a little bismuth sub- 
nitrate may be applied over the sore spots. 



THE AILMENTS OF EARLY INFANCY. 233 

Blisters. — The occurrence of little blisters on the 
child's body, especially on the palms of the hands and 
soles of the feet, is a matter of more moment and should 
at once be brought to the attention of the physician, as 
also should sores around the finger nails. These indicate 
a condition of the blood for which the use of remedies 
prescribed by the physician will be necessary. The 
technical name for the rash is pemphigus. 

Prickly Heat, or Miliaria, consists of pin-head sized, 
red elevations closely crowded over the portions of the 
body where there is most perspiration. It often results 
when children are too warmly dressed, or in hot weather. 
The treatment consists in the substitution of lighter 
clothing, with the relief of the skin irritation by the use 
of some powder, as camphor, one part to eight parts 
powdered starch. A little magnesium may be given by 
mouth. 

Stomach Rash is a name given to an eruption known 
as erythema — a redness of the skin, with the occurrence 
of pimples — caused by indigestion. 

Eczema is a disease which is much more troublesome. 
It may last months. There is usually an inherited tend- 
ency to some constitutional trouble ; or improper food 
(especially starchy foods), or imperfect hygiene may be 
responsible for it. The surface is swollen, red and 
moist; thick crusts often form. There is intense itch- 
ing. Such cases should always be under the care of 
a physician. A saturated solution of salicylic acid, with 
the subsequent application of zinc ointment, often greatly 



234 OBSTETRIC NURSING. 

relieves the distressing symptoms, and in time removes 
the rash. 

Milk Crust consists of large, yellowish patches on 
the head, and is really dandruff. Castor-oil should be 
used to remove the patches, and the head kept cleansed 
with borax and water. 

The Whites. — Sometimes a whitish, glairy discharge 
comes from the privates of little girl babies. This is 
simply the matter found there at birth. Occasionally 
a little blood may be mixed with it, the result of an 
abrasion in the vagina, and may last a day or two. The 
nurse need not be afraid to remove this matter ; in fact, 
if left, it causes irritation of the skin. 

Suppression of Urine. — A healthy baby usually wets 
its napkin very frequently — it may be, every hour during 
the day, and four or five times at night. Sometimes 
several hours may pass, and yet the napkin remain dry. 
Either of these conditions may exist in health, being 
dependent largely upon the weather, the food, etc. If 
urine is not passed for twelve hours, the condition should 
be reported. 

The nurse may try to make the baby urinate by using 
fomentations over the bladder and kidneys before report- 
ing the matter to the physician. If a baby cries when 
urinating, a careful examination must be made of the 
water-passage to see whether there is any cause for irri- 
tation, as the urine may be irritating. In boy babies 
there is sometimes a very long narrow foreskin which 
tends to become adherent to the parts beneath it. 



THE AILMENTS OF EARLY INFANCY. 235 

Phimosis is the name given this condition. For its 
management a nurse should be taught to retract the 
foreskin daily, oiling the surface beneath with a little 
castor-oil applied with a camel's hair brush or stick 
twisted with cotton. For irritating urine, giving the 
baby frequently a drink of cold water is usually sufficient. 

Chafing. — The skin of new-born babies is soft and 
thin, and apt to become sore, especially when two sur- 
faces rub. First, a little crack is noticed, next day this 
will have widened until, sometimes, a large surface is left 
bare. To prevent this, proper care of the baby from 
the very beginning is important. Never use soap. Use 
warm water in washing it, either plain warm water or 
water with sufficient powdered borax to make it soft, and 
wash the part very carefully ; wipe or mop carefully with 
a soft cloth. Then, to prevent further rubbing of the 
parts, particularly if the skin be broken, use a piece of 
patent lint or soft Canton flannel, with some salve, as 
zinc ointment, containing twenty grains of boric acid to 
the ounce, spread over it, and carried into the crease be- 
tween the rubbed surfaces. This should be changed at 
least three times a day, or as often as the baby soils the 
napkin. A very healing ointment consists of about two 
drams of bismuth to the ounce of zinc ointment. The 
paste of equal parts of bismuth and castor-oil is also 
very nice for the purpose. 

Boils. — When run down, or suffering from chronic 
digestive troubles, babies often suffer with boils or other 
pustular eruptions. They may arise, too, from conditions 



236 OBSTETRIC NURSING. 

of constitutional disease. When these need to be poul- 
ticed, the only kind of poultice admissible is an antisep- 
tic poultice made by % wringing several folds of clean, 
soft linen out in a hot saturated solution of boric acid 
and covering this with a piece of rubber tissue or paraf- 
fin paper to retain the heat. A little ointment containing 
ichthyol is good in the early stage. When pus exists 
the boil should be lanced. Change of air with tonics 
will often do much to relieve this tendency. 

Fever Blisters. — Children should be kept from pick- 
ing these blisters, which may be treated by the applica- 
tion two or three times a day of the bismuth and zinc 
ointment or any healing ointment. 

Itch is a contagious skin affection, usually found 
among the dirty, but may be contracted by the cleanest 
children. The sides of the fingers, the toes, the buttocks 
may be covered with small pimples and irregular ridges 
where the parasite has burrowed. There is intense itch- 
ing. The thorough and careful use of antiseptics under 
the direction of a physician will be necessary for cure. 

Ringworm is also a contagious skin affection due to 
a fungous growth. The ring-like shape gives it its name. 
Sulphur and tar ointment make a good application for 
this. Ringworm of the scalp is very difficult to cure, and 
should be seen by a doctor. 

Baby's Sore Eyes generally come about from some 
infection of the eyes through the mother's discharges at 
the time of the birth, or in lying-in hospitals one baby 
infects another. Hence, should care be taken to cleanse 



THE AILMENTS OF EARLY INFANCY. 237 

the eyes immediately after the delivery with a saturated 
solution of boric acid, or even clean, warm water, they 
maybe prevented, as a rule, from getting sore. In many 
hospitals a drop of a two per cent, solution of nitrate of 
silver is dropped into the eyes after douching them well 
with boiled water at 98 F. Should the inflammation 
occur, however, the nurse must remember that the affec- 
tion is contagious, through the matter which forms in 
the eye. This matter is capable of setting up an inflam- 
mation elsewhere, as when a towel used about the eyes 
may produce a similar inflammation about the privates ; 
a scratch or wound in the hands may be affected by it. 
The discharge from affected eyes is greenish-white. The 
poison it contains is not destroyed by drying ; it catches 
and clings to the room, as the poison of smallpox. Hence, 
a nurse's hands should be thoroughly cleansed after wash- 
ing the eyes, and the nails cleaned with a nail-brush. 
The cloths used in washing the eyes should be burned 
at once after using. The greatest precautions must be 
taken not to carry the poison. The nurse's chief care, 
apart from preventing the spread of the trouble, in such 
a case, would be to keep the eye or eyes free of the dis- 
charge by frequent cleansings with warm water gently 
syringed into the eye from the inner toward the outer 
angle, the lids being held everted by their gentle separa- 
tion by the thumb and finger of one hand.* This wash- 
ing may need to be done every hour. The baby's hands 

* A warm saturated solution of boric acid is even more efficacious. 



238 OBSTETRIC NURSING. 

should be kept down by fastening a towel around the 
child's body, pinning it in the back. The baby may be 
held between the nurse's knees and its head inclined over 
a basin, which will receive the water from the washing. 
Another basin should contain the clear water to be used. 
Should only one eye be sore, in placing the baby in its 
crib, or laying it down at any time, the nurse should be 
careful to place it with the sore eye down, so that any 
discharge from it may not enter the other eye. Any 
further irritation, as of a strong light, should be pre- 
vented by keeping the baby in a darkened place. Want 
of attention in these cases may cause a child the loss of 
its sight. A room occupied by a baby with sore eyes 
must afterward be carefully disinfected. When the eyes 
are inflamed, the application of ice-cloths every two or 
three minutes, kept up persistently until the inflammation 
subsides, is most efficacious. A piece of ice with small 
squares of linen laid upon it can be kept at the side of 
the crib so as to be ready for constant use. The cloths 
removed should be burned. 

There is a law in many States, Penns)lvania included, 
requiring nurses or mothers having an infant in charge, 
who is not under the care of a medical attendant, to re- 
port promptly to the Board of Health any appearance 
of inflammation about the eyes. 

Snuffles, or a Cold in the Head, shown by watery 
eyes, sneezing, stopping up of the nose, hence difficulty in 
nursing, should be managed by keeping the nose cleaned 
out by means of soft linen twisted into a cone, greasing 



THE AILMENTS OF EARLY INFANCY. 239 

the nose well afterward with a little oil by carrying it up 
the nostrils on a twist of cotton, greasing the outside of 
the nose between the eyes, and keeping the baby warm. 
If the baby has no hair, the head may be kept warm by 
a little mull (or in winter thin flannel) cap. 

Running at the Ears is generally very serious in 
new-born babies, especially when the discharge is matter 
or blood. Some trouble with the brain may be threatened, 
hence the physician should be told of it as soon as it is 
noticed. Of course, the discharge entering the ears at 
the time of the birth should be carefully excluded from 
this disorder. 

Earache. — A persistent cry, with the raising of 
the hand persistently to the head, will often indicate 
earache. No medicine should be dropped into the 
ear and no poultice placed over it. The pain is often 
relieved by holding a hot water bag or bottle to the ear. 
Relief is also often obtained by syringing the ear with 
water as hot as can be borne. This should be done 
frequently, and the ear kept covered in the intervals 
with hot, dry flannel. 

The Breasts of new-born babies often swell. Gen- 
erally this occurs about the seventh day or during the 
second week. Occasionally they gather, and must then 
be lanced by the physician. Nothing should be done for 
this swelling, except to see that the clothing is loose. It 
disappears in a few days, as a rule. 

Scalp Tumors. — The same may be said of swellings 



24O OBSTETRIC NURSING. 

on the head or about the face, which are due to pressure 
during the birth. One form of scalp tumor may last 
several weeks before its entire disappearance. The latter 
is the result of temporary injury to the bone, and 
not simply the ordinary swelling which comes from 
interference with the circulation of the blood in the soft 
tissues of this portion of the scalp. The name blood- 
tumor (hematoma) is applied to this. No active treat- 
ment for its removal is necessary. 

Deformities. — A child may be born with some de- 
formity, as hare lip, or cleft-palate, or club-foot, or ex- 
tra fingers and toes, or there may be some malfor- 
mation about the external organs of generation or 
the bowel. The bowel passage may be closed, or there 
may be no opening from the bladder. Whatever the 
deformity may be, the nurse should avoid letting the 
mother know anything about it until the physician has 
told her of it. The shock produced by the knowledge 
may do the mother much injury; hence the physician 
should bear the responsibility of making the announce- 
ment. A nurse will need considerable tact in man- 
aging this, as the mother is apt to ask to see her baby 
very soon after its birth. An excuse may be made by 
stating the necessity for washing and dressing the child 
first, or it maybe asleep and the nurse hesitate to disturb 
it. A child with hare-lip or cleft-palate will need to be 
fed, as a rule, with the spoon or a dropper, as it cannot 
nurse. 



THE AILMENTS OF EARLY INFANCY. 24 1 

Tongue-tie. — Quite frequently the bridle beneath the 
baby's tongue is too short, and interferes with the free 
movement of the tongue. This is called " tongue-tie." It 
may prevent the child's nursing, and thus interfere with 
its nutrition. If the baby can extend the tip of the 
tongue beyond its lips, it is not probable that there will 
need to be anything done, as the baby ought to be able 
to suck a good nipple with ease. If the nurse should 
introduce the tip of her little finger into the baby's 
mouth and allow the child to draw on it for a few 
minutes, she can tell whether the act of sucking can be 
properly accomplished. Should it not be able to suck, 
the attention of the physician should be called to the 
matter, as the bridle will have to be nicked — an opera- 
tion following which there may be considerable loss of 
blood, hence it should not be attempted except by a 
physician. 

Bleeding from the Cord or navel string may occur 
within a few hours after birth. It may be that the cord 
has not been tied sufficiently tight, or there may have 
been a very thick cord, which, in shrinking, has loosened 
the ligature. If, after tying, the cord has been looped 
back upon itself and tied in a single double bow-knot, 
this may be untied by the nurse and fastened more 
tightly, so that the bleeding may be controlled, or an- 
other ligature may be thrown around the cord a little 
nearer the body of the child than the first one. Should 
this not check the hemorrhage, the nurse should hold 

the cord firmly between the thumb and finger, making 
16 



242 OBSTETRIC NURSING. 

compression until the physician, who should be sent for, 
arrives.* 

Falling of Cord. — The cord commonly falls off about 
the fifth day. The process of ulceration, by which it 
falls off, leaves an open surface on the child's body 
which offers an ayenue for septic infection. Great care 
should therefore be taken that the nurse's hands and any- 
thing else that comes in contact with this surface are 
perfectly clean. Should any moisture exist about the 
stump, the use of the antiseptic powder of salicylic acid 
and starch, before spoken of, or some other drying pow- 
der of the kind, is indicated. It is necessary, also, to 
see that the dressing used is thoroughly antiseptic. 
When infection does exist, it shows itself in the occur- 
rence of inflammation around the navel or some other 
part of the body; the child loses flesh, has fever, be- 
comes puny and emaciated, and abscesses form in va- 
rious places. In the majority of cases it dies, not having 
sufficient vitality to survive the poisoning.f 

The physician will, of course, prescribe the treatment 
for such a child ; the nurse will be required to see that 
these directions are faithfully carried out, and especially 

* Bleeding from the base of the stump after the cord has fallen is a 
more difficult condition to manage. The physician needs sometimes to 
control the hemorrhage by a ligature drawn beneath transfixion pins. The 
nurse must keep up pressure over the site until the doctor comes. If this 
is a simple oozing a free application of powdered tannic acid with a com- 
press is all that is necessary. 

f Sometimes the inflammation takes on the character of erysipelas. 



THE AILMENTS OF EARLY INFANCY. 243 

that the child gets all the nourishment and stimulation 
required. 

Umbilical Vegetations are either soft, jelly-like 
growths, or, which is more common, hard protuber- 
ances sometimes the size of a hickory-nut. They are 
not painful and seldom bleed. The physician some- 
times removes them by ligature. The softer forms may 
be touched with caustic and thus made to shrink. 
When an ulcer exists at the place from which the cord 
dropped, it can be kept dusted with a drying powder, 
as boric acid and zinc oxid or a little tannic acid 
powder. 

Jaundice. — A peculiar yellowish coloration of the 
skin is to be noticed with babies a few days after the 
birth. This disappears, as a rule, by the end of the 
second week, and is due to changes in the circulation. 

Should the jaundice be very marked and seem to per- 
sist, warm baths once or twice a day, with gentle friction 
over the liver with soap liniment, helps, with free action 
of the bowels, to overcome the condition. Jaundice of 
the new-born baby is sometimes the result of disease of 
the liver. The color is then very marked. The baby 
grows thin rapidly and appears sick. The stools are 
apt to be clay-colored. When the child is suffering 
from blood-poisoning, the peculiar coloration of the skin 
is due to this cause. 

Buhl's Disease is an obscure disease of new-born 
babies, thought to be due to fatty degeneration of the 
internal organs. It results fatally, as a rule, within the 



244 OBSTETRIC NURSING. 

first few days. There is a tendency to hemorrhage from 
various parts of the body. 

Bleeders. — In some families known as " bleeders," 
the tendency to hemorrhage may be transmitted to the 
child, particularly if it be a boy. It is necessary to 
watch for any such tendency very closely. The hem- 
orrhages may occur from any open surface on the body, 
or from the mucous surfaces. Tarry stools occurring after 
the normal bowel passages have been established would 
be an indication of intestinal hemorrhage. Sometimes 
the hemorrhage is in the brain and the child dies with 
symptoms of brain trouble. 

Convulsions may occur in very young infants at 
varying periods after their birth, according to the cause 
which excites them, as, injury during labor, indigestion, 
brain trouble, or other causes. The convulsive seizure 
is generally preceded by twitching of the limbs, a rolling- 
up of the eyeballs, so that a large part of the whites of 
the eyes is seen, the thumbs are drawn into the palms 
of the hands, and the fingers tightly clasped over them, 
or the toes may be turned upward or drawn downward. 
During the convulsion the child grows rigid. 

When the attack comes on the nurse should quickly 
undress the child and place it in a warm bath. A table- 
spoonful of mustard added to the water will help to 
stimulate the skin, and the convulsion will gradually 
subside. The child, on its removal from the bath, may 
be wrapped in a heated blanket, and allowed to perspire 
freely. On the recurrence of the convulsion, the same 



THE AILMENTS OF EARLY INFANCY. 245 

measure of placing the child in the bath should be re- 
sorted to, until the physician comes and institutes such 
other treatment as he may think proper. The use of an 
ounce of milk of asafetida by bowel is often efficient in 
quieting nervous irritability. 

Bruises, the result of falls or blows, should be treated 
by the repeated application of hot or cold compresses. 
This will relieve pain and prevent swelling, and the 
black and blue coloration of the skin which would other- 
wise result. 

The occurrence of a fall or blow should be carefully 
reported by a nurse, as the child should be carefully ex- 
amined for the discovery of any injury the serious con- 
sequences of which may be averted by prompt treatment. 
The occurrence of paleness or vomiting after any such 
accident is a serious symptom and should receive im- 
mediate attention by the physician. «• 

Fever. — A hot, dry skin may accompany various of 
the disorders of infancy, notably inflammatory condi- 
tions of the digestive organs and of the lungs. The 
normal temperature of a new-born baby is 99 Fahr., 
the pulse 140, the respiration 44. 

Should the child seem to be ailing, its temperature 
should be taken. A clinical thermometer may be held 
the requisite number of minutes in the groin or in the 
folds of the neck. Some slip the bulb of the thermome- 
ter into the rectum. Should the temperature be raised, 
the pulse rapid, and the respiration hurried and difficult, 
some lung trouble probably exists. Pneumonia is a very 



246 OBSTETRIC NURSING. 

common disease with infants. A catch in the breath, 
noisy breathing, a distention of the nostrils on taking an 
inspiration, would indicate the same thing. The fre- 
quent rubbing of the chest with some counter-irritant 
liniment, as St. John Long's liniment, the use of the 
cotton-jacket for the protection of the chest, and, if the 
child is very feverish, sponging it frequently with tepid 
water, and the use of a drop of sweet spirits of niter in a 
teaspoonful of cold water once in two hours or oftener, 
will constitute the nurse's management of the case until 
the doctor has seen the baby and laid down his plan of 
treatment. The cotton-jacket is made by taking a high- 
necked, long-sleeved merino vest a size or two larger 
than would be needed by the baby for ordinary wear, 
opening it down the front, and fastening tapes an inch 
or two from each edge in front, by which the jacket 
*may be closed. The inner surface of this vest, back and 
front, should be quilted with sheep's wool or cotton 
batting, the outer surface with oiled silk or oiled muslin. 
This makes a very warm covering for the chest. 

Infectious Diseases, such as scarlet fever, measles, 
etc., are very rare under the age of one year, especially 
under six months, therefore do not need to be consid- 
ered here. Occasionally when the mother has the affec- 
tion or has been where these diseases are, immediately 
before or at the time of the baby's birth, the child will 
have the disease or develop it. The treatment must be 
managed by a physician. 

Cyanosis, or " blue disease," comes from the imper- 



THE AILMENTS OF EARLY INFANCY. 247 

feet closure of an opening which exists in the heart 
before birth. The baby is called a " blue baby," and is 
very delicate in consequence of this imperfection in its 
circulation. Such babies generally die, if not during 
infancy, some time during early childhood. With great 
care they sometimes live, and the opening in the heart 
gradually closes up. The special care required is to 
keep the child warm and to handle it very carefully, so 
that it may be subjected to no jar or nervous fright. 
The child should be kept lying on its right side, or on 
its back, in order that, there may be as little interference 
as possible with the action of the heart, and that the 
tendency of the blood to flow through this opening in 
the upper chambers of the heart — from right to left — 
may be overcome. 

Rickets is a disease of the bones — the result of poor 
nutrition. There is not sufficient deposit of earthy 
matter in the bones, hence they remain too soft and are 
subject to all kinds of distortions in consequence of this. 
The child may be bow-legged and is stunted in its 
growth, curvatures of the spine may exist, or an unnatu- 
rally large head, known as hydrocephalus, or " water on 
the brain." 

Scrofula is a term applied to a form of tuberculosis 
common among children. It shows itself in the tend- 
ency to enlargement of the glands, especially of the 
neck — the occurrence of abscesses and sore and weak 
eyes. Such cases should always be under the care of a 
physician. 



248 OBSTETRIC NURSING. 

Marasmus is a term used to indicate a condition of 
persistent wasting in a child from whatever cause. The 
child becomes excessively thin, the skin yellowish, the 
face wrinkled. Tuberculosis, syphilis, persistent, diar- 
rhea, and vomiting are apt to produce it. 

The baby having this disease is very weak, cannot 
hold up its head well, perspires very freely, especially 
about the head. The complexion is very white. The 
baby has constant trouble with its bowels, having green 
stools nearly all the time. The opening in the front of 
the head is depressed and the child seems to waste. 

As the baby grows older, unless well cared for, the 
evidences of disease increase, the joints are enlarged, the 
baby cannot support itself on its limbs, its teeth are slow 
in coming, etc. 

The mother can do much for the health of her child, 
while still carrying it, by a careful regard for her own 
general health. After the baby's birth it should be kept 
well nourished, to overcome any tendency to disease. 
Salt baths, oil baths, and the use of tonics ordered by the 
physician, as cod-liver oil, together with careful atten- 
tion to the quality and quantity of nourishment, will do 
much to prevent the progress of any wasting disease. 

Water on the Brain, or Hydrocephalus. — An en- 
largement of the head is sometimes found even with very 
young infants, due to an accumulation of fluid within the 
skull, which results from a form of chronic inflammation. 
In mild cases the mind is not affected, and the child 
seems to outgrow the condition. 



THE AILMENTS OF EARLY INFANCY. 249 

Paralysis of one side of the face or of an arm some- 
times result from pressure during the birth. The baby 
usually recovers from this in a few weeks. Another 
form of paralysis sometimes occurs with infants which 
is due to disease of the spinal cord. These cases require 
intelligent medical supervision. 

Vaccination. — The question often arises as to how 
soon a baby should be vaccinated, particularly if small- 
pox be prevalent. As a matter of experience, it is found 
that the vaccination does not " take " well before the 
third month, though, if a younger baby is to be exposed 
to the poison, it would be well to have it vaccinated. 
Vaccination should be avoided, if possible, when the 
baby's health is run down from any cause, also at the 
time of teething. A peculiar and distressing form of 
rash sometimes occurs, or there is a great deal of inflam- 
mation following the vaccination, leading the parents to 
imagine that the baby has been poisoned by the virus 
used. 

Care should be taken to see that the child does not 
scratch the sore, and that it is kept free from the rub- 
bing of the clothing. No grease should be applied 
unless directed by the physician. Where there is much 
redness and intense itching the physician may direct 
some powder or ointment to be applied to allay this. 

A soft, clean linen handkerchief can be bound over the 
sore, and a loose-sleeved garment used to prevent the 
irritation of rubbing. Applications which are not aseptic 



25O OBSTETRIC NURSING. 

when used about such a sore, may induce blood poi- 
soning. 

An insight into the frailty of human life in its earliest 
days proves how much the world owes to the faithful- 
ness of mothers and nurses, and should be a stimulus to 
scientific research in the discovery of improved methods 
for the management of infancy. 



INDEX. 



Abdominal bandages, 76 

Accidents of labor, 109 

of pregnancy, 51-56 

After-birth, position for, 
delivery, 120 
disposal of, 106 

After-pains, 152 

Ailments of infancy, 210-250 

Airing of infant, 196, 197 

Anesthesia, 126 

Antisepsis, 57 

during labor, 64 

Antiseptic solutions, 95 96 

dressings, 77, 78, 107 

Antiseptics, 65 

Artificial breathing, 111-118 

Attentions after labor, 106, 108 

Auvard's couveuse, 215, 216 



B. 

Baby's basket, 84, 85 

Bag of waters, 88 

Bandages for breasts, 142-148 

forvaricose veins, 38-39 

Barley water, 224 

Bathing during pregnancy, 47, 134 

Binder for baby, 81 

for mother, 76, 107 

Birth-marks, 232 

Bladder, 34, 35, 134 

Bleeders, 244 

Bleeding from cord, 241 

Blisters, 233 

Boils, 235 

Boston bandage, 148 

Bowel-movements, 222 

Breasts, anatomy of, 22 

care of during pregnancy, 41 
care of after labor, 138-152 
caked, 144 



Breasts, gathered, 150 
of infant, 239 
Breech delivery, 122 
Bruises, 245 
Buhl's disease, 243 



Caked breasts, 144 

Catheter, 34, 135, 136 

Cereals, 226 

Chafing, 235 

Chorea, 49 

Cleft palate, 240 

Clothing during pregnancy, 42, 47 

of infant, 81, 84, 169, 170 

of nurse, 92 
Cold in head, 238 
Colic, 220 
Colostrum, 175, 176 
Complications of pregnancy, 49 
Conception, 24 
Constipation of infants, 229 
of mother, 32 
Convulsions during labor, 124 

during pregnancy, 55 
Cord, care of, 167 
Couveuse, 211, 216 
Cows' milk, 180 
Cramps during labor, 104 
Cream, 182 
Crib, 171, 173 
Cries of infant, 204 
Cross-bed, 125' 
Cyanosis, 246 

D. 

Deformities of infant, 240 
Delivery, position for, 105 
Deportment of nurse, 124 
Development of infant, 198 
Diarrhea of infant, 222 



251 



252 



INDEX. 



Diarrhea of patient, 33 

Diet after labor, 129, 131 
during pregnancy, 48 
of infants, 173, 174 

Dress for nurse, 92, 93 

Drink for baby, 174 

Disinfection, bedding, 73 
catheter, 67 
clothing, 68, 73 
dressings, 66 
mattresses, 74 
nurse's hands, 66 
room, 68 
rubber-sheets, 68 
vaginal nozzles, 67 
vulva, 67 
water-closets, 74 

Duration lying-in, 131 

Duties of nurse during labor, 92, 108 

Dysmenorrhea, 24 



E. 

Earache, 239 
Eczema, 233 

Emergencies of labor, 109 
Emotions, maternal, 49 
Epilepsy, 49 
Erythema, 233 
Etherization, 126 
Exercise during pregnancy, 49 
Experiments (bacteriological), 61, 63 
Expression of infant, 205 
Eyes of new-born, 100-105, 170, 200, 236, 
238 



Falling of cord, 242 
Fallopian tubes, 21 
Farinaceous foods, 228 
Feeding of infants, 173, 174 
in indigestion, 223 
Fever-blisters, 236 
Fevers, 245 
Flour-ball, 226 
Fontanelles, 199, 200 
Food during pregnancy, 32, 48 

after labor, 1 29-1 31 
Formulas for infant feeding, 187, 1! 
Fractional sterilization, 183 
Friends, 104 



Galactagogues, 177 
Galactorrhea, 151 
Garrigues' bandage, 144 
Gavage, 219, 220 



Gelatin, 225 
Germs, 58-63 
Gertrude suit, 



83 



H. 



Hair, baby's, 170, 200 
Hand-feeding, 180 
Hare-lip, 240 
Hearing of infants, 200 
Heart-trouble, 50 
Hematoma of scalp, 240 
Hemorrhage during pregnancy, 51, 52 
labor, 122 124 
from varicose veins, 53 
Hemorrhoids, 37 
Hernia of infants, 230 
Human milk, 176 
Humanized cows' milk, 182 



Increase in weight of infant, 181 
Infants' foods, 225 
Inflammation of bowels, 223 
Injections for infant, 229 

intra-uterine, 153 
Insanity, 49 
Involution, 13T 
Itch, 236 



Jaundice, 243 
Jenness-Miller clothing, 43 



K. 

Kidneys, during pregnancy, 35 



Labor, preparations for, 75-85 

signs of, 86 

stages of, 88-91 
Laborde's method of resuscitation. 
Lactation, 175 
Lactometer 178 
Leucorrhea, 36 
Liebig foods, 228 
Lime-water, 224 
Lochia, 132 
Lying-in, 127 162 

M. 

Management of labor, 109-124 
Marasmus, 248 



.18 



INDEX. 



253 



Meconium, 168 
Mellin's food, 225 
Menorrhagia, 24 

Methods for calculating date of confine- 
ment, 29-31 
for resuscitation, 113, 118 
Metrorrhagia, 24 
Miliaria, 233 
Milk, analysis of, 176, 181 
insufficient, 151, 175 
preparations of, 182-193 
substitutes for, 227-229 
-crust, 234 
-foods, 228 
-leg, 157 
Miscarriages, 53 
Molding of infant's head, 199 



N. 

Neighbors, 104 

Nervous diseases of pregnancy, 49 

Neuralgia, 39 

New-born, care of, 164-197 

Nightingale wrap, 78, 79 

Nipples, care of after labor, 139-141 

care of during pregnancy, 41-42 

protector, 42 

rubber, 195 

shield, 140 
Nourishment during labor, 103 
Nursing bottle, 193-194 



o. 

Operations, obstetric, 124-126 
Order-board, 163 
Outfit of baby, 81 

of patient, 96, 97 
Ovaries, 22 



Pains false, 87 

of labor, 87 
true, 87 
Paralysis, 249 
Pasteurization, 184 
Pelvis, anatomy of, 17 

contents of, 17-20 
measurements of, 17 
Peptonized food, 186, 187 
Phimosis, 235 
Piles, 37 
Placenta, disposal of, 106 

position for delivery, 120 
Poisoning, blood, 69 

from antiseptics, 69-71 



Powder, use of, 166 

Pregnancy, management of, 32-50 

signs of, 25-29 
Prematurity, 210-220 
Preparation of patient for labor, 94-97 

of room, 97-103 
Prickly heat, 233 

Prochownick's method of resuscitation, 117 
Prolapsus cord, etc., 124 
Puerperal fever, 156 

mania, 158-159 

ulcers, 156 

Q- 

Quality food for infant, 181 
Quantity, 230 

R. 

Red gum, 232 

Report, 154, 155 

Resuscitaiion of infant, 111-118 

Respiration of infant, 202 

Ringworm, 236 

Rickets, 247 

Running at ears, 239 

Rubber-cloth, 80 

Rules for feeding infants, 230 

management couveuse, 213-216 
management lying-in wards, 65 
management premature infants, 
210-220 

Rupture in infants, 230 

of membranes, 54-88 
of uterus, 124 



Salivary glands, 40 

Scalp-tumors, 239, 240 

Schultz method of resuscitation, 

Scrofula, 247 

Sea-voyages, 47 

Senses of infant, 200 

Septic infection, 60 

Sitting-up, first, 160. 161 

Skin of infant, 198 

Sleep, after labor, 127 

of infants, 202 
Snuffles, 238 
Soap-suppository, 229 
Soiled clothing after labor, 128 
Sore-eyes, 236, 238 
Sore-mouth, 204 
Sponge-bath, 171 
Sterilized milk, 183, 189-193 
Sterilizer, 191, 196 
Stomach of infant, 186 



115, in 



254 



INDEX. 



Stomach rash, 233 

Stools of infant, 205 

Suppression of urine, 234 

Sylvester method, resuscitation, 113, 114 

Symptoms, observation of, 154 

Syphilis, 50 

Syringe, 80 



Tact, 104 

Tarnier's couveuse, 212 

Teeth of infants, 206-208 

during pregnancy, 40 
Temperature, high, 50 

of infant, 206-20$ 
Toilet, first, of infant, 164 
Tongue-tie, 241 
Training of infant, 173 
Tub, infant's, 172, 173 
Twins, 120 
Tying-cord, 118 



u. 



Umbilical vegetations, 243 

Urinary organs, during pregnancy, 34-36 



Urination of infant, 205 
Uterus, 21 



Vaccination, 250, 254 

Vagina, 20 

Vernix caseosa, 164 

Visitors, 128 

Vomiting during labor, 103 

during pregnancy, 40 
of infants, 230 



w. 

Walking of child, 208, 209 
Washing for infant, 128 

for mother, 128 
Weaning, 227 
Weighing of infant, 170 
Weight of infant, 201 
Wet-nurse, 175 
" Whites " in infants, 234 
Worms, 231 



Y. 



" V bandage, 148 



Catalogue No. 5. JULY, 1895, 



BOOKS M NURSES. 



FOR NURSES AND ALL ENGAGED 
IN ATTENDANCE UPON THE SICK, 
OR THE CARE OF CHILDREN. 



jfjlP* Dealing exclusively in books on medicine 
and collateral subjects, we are able to give special 
attention to supplying books for nurses. We have 
a large stock of works on Nursing, Hygiene, 
Popular Medicine, etc., Temperature Charts, etc. 

Catalogues of Books on Medicine, Dentistry, 
Pharmacy, Chemistry, etc., free, upon application. 

Special attention given to orders to be forwarded 
to a distance, by mail or express. Upon receipt of 
the price, any book will be delivered, free, to any 
address. See page 2 for directions for ordering 
books by mail. 

P. Blakiston, Son & Co., 

IOI2 WALNUT STREET, PHILADELPHIA. 

J&g^The prices as given in this catalogue are net. 
No discount can be allowed retail purchasers. 



IT COSTS YOU NOTHING 



TO 



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OUR STOCK OF MEDICAL BOOKS, AMERICAN AND ENGLISH, 

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BOOKS ON DENTISTRY; BOOKS ON PHARMACY. 

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P. BLAKISTON, SON & CO.'S publications may be had through 
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HUMPHREY'S 

MANUAL OF NURSING. 

MEDICAL AND SURGICAL. 



A complete Text- Book for Nurses, including General Anatomy 
and Physiology, Management of the Sick-Room, Appliances used 
in Sick-Room, Antiseptic Treatment, Bandaging, Cooking for 
Invalids, etc., etc. 

Thirteenth Edition. With 79 Illustrations. 

BY LAWRENCE HUMPHREY, M.A., M.D. 

12MO. CLOTH. PRICE $1.00. 



St. Joseph's Hospital, 

Seventeenth and Girard Avenue, 

Philadelphia, March 15, 1893. 
Messrs. P. Blaki'ston, Son &* Co. : — 

Please send us six more copies of Manual of Nursing, by Humphrey. We 
do not know of any book that more completely meets the requirements of a 
Training Class than Dr. Humphrey's able Lectures, for they are at once clear, 
concise, and thoroughly practical. Sisters of Charity. 



From British Medical Journal, London. 

"Nursing literature is expanding, and, what is more to the purpose, it shows 
manifold signs of improvement with its growth. In the fullest sense, Dr. 
Humphrey's book is a distinct advance on all previous manuals. It is, in point 
of fact, a concise treatise on medicine and surgery for the beginner, incorporat- 
ing with the text the management of childbed and the hygiene of the sick-room. 
Its value is greatly enhanced by copious wood-cuts and diagrams of the bones 
and internal organs, by many illustrations of the art of bandaging, by tempera- 
ture charts indicative of the course of some of the most characteristic diseases, 
and by a goodly array of sick-room appliances, with which every nurse should 

endeavor to become acquainted The systematic arrangement of 

subjects adopted by the author is excellent." 



THE BEST GENERAL TEXT-BOOK. 



NURSING IN 

ABDOMINAL SURGERY 

AND 

DISEASES OF WOMEN. 

A Series of Lectures Delivered to the Pupils of the Training School 

for Nurses Connected with the Woman's Hospital of 

Philadelphia, comprising their Regular Course 

of Instruction on such Topics. 

BY ANNA M. FULLERTON, M.D., 

Physician-in- Charge of and Obstetrician and Gynecologist to the Woman's 
Hospital of Philadelphia, etc. 

SECOND EDITION, REVISED. 
12mo. 300 Pages. 70 Illustrations. Cloth, $1.50. 

*^* The immediate success of Dr. Fullerton's " Handbook of 
Obstetrical Nursing," a third edition of which has just been pub- 
lished, has encouraged her to prepare this manual on another and 
very important branch of the science and art of nursing. Dr. 
Fullerton has demonstrated that she not only knows what to say, 
but that she has the happy faculty of saying it in a plain, practical 
style that interests as well as instructs. 

Synopsis of Contents. — The Surgical Nurse — The Germ Theory 
of Disease — Asepsis and Antisepsis — Abdominal Section — The Pre- 
paration of the Room — The Preparation of Sponges — Sterilization 
of Instruments, etc. — Preparation of the Patient — Preparation of 
Operator and Assistants — The Nurse's Duties During Operation — 
The Nurse's Duties After Operation and During Convalescence — 
Management of Complications — The Pelvic Organs in Women — 
Diseases of Women — General Nursing in Pelvic Diseases — Pre- 
parations for Gynaecological Examinations — Preparation for Gynae- 
cological Operations — Preparation of Patient, Operator and Assist- 
ants — Duties of Nurse During Operation — Special Nursing in 
Gynaecological Operations — Diet for the Sick — Supporting Treat- 
ment of Abdominal Sections — Index. 



A HANDBOOK 



OBSTETRICAL NURSING. 

Comprising the Course of Instruction in Obstetrical Nursing 

given to the Pupils of the Training School for Nurses 

connected with the Woman's Hospital of Philadelphia. 

BY ANNA M. FULLERTON, M.D., 

Demonstrator of Obstetrics in the Woman' s Medical College of Pennsyl- 
vania ; Physician-in- Charge and Obstetrician and Gynaecologist to the 
Woman's Hospital of Philadelphia, and Superintendent of the 
Nurse Training School of the Woman's Hospital of Philadelphia. 

38 Illustrations. 12mo. Handsome Cloth, $1.25. 

THIRD EDITION— REVISED. 

Synopsis of Contents. — The Pelvis and Genital Organs — 
Signs of Pregnancy — Management of Pregnancy — Accidents of 
Pregnancy — Germs and Antisepsis — Preparations for the Labor 
— Signs of Approaching Labor and the Process of Labor — Duties 
of the Nurse during Labor — Accidents and Emergencies of Labor 
— Care of the New-born Infant — Management of the Lying-in — 
Characteristics of Infancy in Health and Disease — The Ailments of 
Early Infancy — Index. 

" It is a book that I have recommended since I first saw it, and we are using 
it for our nurses at the N. Y. Infirmary, where we have a branch of our School, 
our nurses going there for instruction in obstetrics." — Mrs. L. W. Quintard, 
Supt. Connecticut Training School for Nurses, New Haven, Conn. 

' * It is the most modern and complete book I have ever read for the care of 
obstetrical patients. I shall take pleasure in recommending it to this school for 
study." — E. L. Warr, Supt. Training School for Nurses, City Hospital, St. 
Louis, Mo. 

" I have looked it over and read it with care, and think it is the best book I 
have ever seen on the subject. It is practical, with plain instructions, nothing 
superfluous. A good book for nurses and teachers of nurses." — Miss Anna 
G. Clement, Supt. of Nurses, The Henry W. Bishop Memorial Training 
School for Nurses, Pittsfeld, Mass. 

" I consider the book excellent in every particular. Would recommend it to 
every nurse, whether she did obstetrical nursing or not." — Gertrude Mont- 
fort, Supt. of Nurses, New England Hospital for Women and Children^ 
Boston, Mass. 

" What is to be learned in a maternity training school is the way to nurse as a 
profession. * * * Can recommend it as a valuable manual."— From the Amer- 
ican Journal of Medical Sciences. 



BOOKS ON NURSING. 



VOSWINKEL. Surgical Nursing, a Manual for 
Nurses and Students, including Complete Chapters 
on Bandaging, Dressings, Splints, etc. By Bertha 
M. Voswinkel, Graduate of the Episcopal Hospital, 
Philadelphia; Nurse in Charge of Children's Hos- 
pital, Columbus, Ohio. With in Illustrations. 121110. 
168 pages. Cloth, $1.00 

SHAWE. Notes for Visiting Nurses, and all 

those Interested in the Working and Organization of 
District, Visiting, or Parochial Nurse Societies. By 
Rosalind Gillette Shawe, District Nurse for the 
Brooklyn Red Cross Society. With an Appendix 
explaining the Organization and Workings of various 
Visiting and District Nurse Societies, by Helen C. 
Jenks, of Philadelphia. i2mo. Cloth, $1.00 

CULLINGWORTH. A Manual of Nursing, 
Medical and Surgical. By Charles J. Cul- 
lingworth, m.d., Physician to St. Mary's Hospital, 
Manchester, England. Third Edition. With 18 
Illustrations. i2mo. Cloth, .75 

BY THE SAME AUTHOR. 

A Manual for Monthly Nurses. Third Edi- 
tion. 32mo. Cloth, .40 

" This small volume is written as a supplement to the author's well-known 
work on nursing. It treats only of the conditions of pregnancy and labor. It 
is clear in its statements, and will prove of great value to those whose duty it 
is to care for women during and after confinement. " — N. Y. Medical Journal. 

DOMVILLE. Manual for Nurses and Others 
Engaged in Attending to the Sick. By Ed. J. Dom- 
ville, m.d. Seventh Edition. With Directions for 
Bandaging, Preparing and Administering Enemata, 
Fomentations, Poultices, Baths, etc., Recipes for 
Sick-room Cookery, Tables of Weights, and a Com- 
plete Glossary of Medical Terms. Cloth, .75 



BOOKS ON NURSING. 



CANFIELD. The Hygiene of the Sick-Room. 

A Book for Nurses and Others, being a Brief Consid- 
eration of Asepsis, Disinfection, Bacteriology, Im- 
munity, Heating and Ventilation, and Kindred Sub- 
jects, for the use of Nurses and Other Intelligent 
Women. By Wm. Buckingham Canfield, a.m., 
m.d., Lecturer on Clinical Medicine, and Chief of 
Chest Clinic, University of Maryland, Visiting Phy- 
sician to Bay View Hospital, etc. 121110. 247 pages. 

Handsome Cloth Binding, #1.25 

*h* This book is the outcome of a series of lectures delivered by 
Dr. Canfield at the University of Maryland Training School for 
Xurses. It contains much valuable information not included in the 
regular text-books, but which of necessity the nurse should be ac- 
quainted with. 

" We recommend it to the attention, not only of sick-nurses, but also all other 
persons, of either sex, who desire a knowledge of the behavior of disease, as it 
concerns infection ; and the manner in which foulness, either of wounded sur- 
faces, or of the sick-room, or of the dwelling-house, may be prevented. 

" Each disease is taken up in turn (typhoid fever, consumption, diphtheria, 
etc.) and the methods of management of the discharges, etc , are described in 
detail. The formulae for the preparation of disinfecting solutions, for clothing, 
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library in vain for are here given in a compact form. 

" The prevention of blindness in infants receives full attention. Ventilation 
is duly considered, and a chapter is given to the thoughtful discussion of immu- 
nity and protection from disease. The book closes with some remarks upon 
the diet of the sick-room. We congratulate Dr. Canfield on his work. It is 
well worth the moderate price." — Maryland Medical Journal. 

GRAPHIC CLINICAL CHART. Designed by 
J. P. Crozer Griffith, m.d. The purpose of this 
chart is to give, in the most concise form, a complete 
record of pulse, respiration, and temperature of the 
patient. Its simplicity and the ease with which it is 
kept commend it to nurses, and the clearness of the 
design makes plain at a glance the full history of the 
case. Price, in packets of 50, .50 



BOOKS ON MASSAGE. 



KLEEN. Handbook of Massage. Cloth, $2.25 
By Dr. Kleen, of Stockholm and Carlsbad. Translated 
by Edward M. Hartwell, a.m. m.d., Director of Physi- 
cal Education, Boston Public Schools, late of Johns Hop- 
kins University, Baltimore. With an introduction by S. 
Weir Mitchell, m.d., of Philadelphia. Illustrated by a 
series of Handsome Engravings, made from fine Pen-and- 
ink Drawings after original photographs made for the pur- 
pose. *^* This is the American Edition of "Kleen's Hand- 
book," which is well known among teachers and experts 
as the most comprehensive and perfect on the subject. 
Several changes and additions have been made at the 
author's suggestion, notably among the latter the set of 
illustrations made from photographs taken by him for this 
edition. No pains have been spared to make this the best 
of standard works upon massage. 

MURRELL. Massotherapeutics. Fourth Edi- 
tion. Or Massage as a Mode of Treatment. By Wm. 
Murrell, m.d., f.r.c.p., Lecturer on Pharmacology and 
Therapeutics at Westminster Hospital, Examiner at Uni- 
versity of Edinburgh, Physician to Royal Hospital for Dis- 
eases of the Chest. Fifth Edition. Revised and Enlarged. 
Illustrated. i2mo. Cloth, 1.25 

" Dr. Murrell particularly dwells on the importance of discrimination in the 
selection of cases and on the special qualifications of a competent manipulator. 
In a word, this essay may be said to convey in a short space most of the infor- 
mation that is at present available in regard to this popular therapeutic agent. " 
— From the London Practitioner. 

" This little volume sets forth clearly all the advantages and disadvantages 
of massage at the present day, and should be in the hands of every Masseuse 
or nurse intending to take up the art. The numerous illustrations of the move- 
ments will prove a great aid. " — From the Trained Nurse . 



OSTROM ON MASSAGE. 



JUST READY. THIRD EDITION. 



Massage and the Original Swedish Move- 
ments. Illustrated. And Their Application to 
Various Diseases of the Body. A Manual for Students, 
Nurses, and Physicians. By Kurre W. Ostrom, 
from the Royal University of Upsala, Sweden ; In- 
structor in Massage and Swedish Movements in the 
Hospital of the University of Pennsylvania and in 
the Philadelphia Polyclinic and College for Graduates 
in Medicine, etc. Illustrated by ninety-three ex- 
planatory Wood Engravings. Third Edition, Revised 
and Enlarged. 121x10. Cloth, $1.00 

" Mr. Ostrom presents to the English public this excellent, systematic manual, 
showing, by illustrations, the various movements and the mode of application to 
all parts of the body. The writer tells for what diseases such movements are 
indicated, with some remarks on the physiology of the movement treatment." 
— From The Philadelphia Public Ledger. 

" In this volume the author gives an excellent description of the methods of 
massage and Swedish movement, together with their applicability to various 
diseased conditions of the body. The methods are rapidly becoming popular- 
ized in our own country, and the perusal of such a book as Mr. Ostrom has 
written will be of great advantage to physicians, for whose use it is mainly in- 
tended." — From the Journal of the American Medical Association. 

" .... Our author has performed a useful service in publishing this 
brief and clearly written manual, and we can recommend it to all who wish to 
gain a knowledge of a method of procedure which is daily finding more favor 
in professional circles. The price of the volume should also insure it a wide 
circulation." — From the Edinburgh Medical Journal. 

" The descriptions are clear, and so well supplemented by the illustrations, 
that anyone with this book, and a subject on which to practice, could undoubt- 
edly become proficient in the art of massage. An excellent feature is the simple 
classification of the manipulations adopted by the author, which makes the 
whole subject much easier to grasp." — From the Medical News , Philadelphia. 



ANATOMY A ND P HYSIOLOGY, 

POTTER'S Anatomy. Fifth Edition. 117 
Illustrations and 16 Lithograph Plates. A 

• Compend of Human Anatomy. By Saml. O. L. 
Potter, m.a., m.d., m.r.c.p. (Lond.), Professor of 
the Practice of Medicine, Cooper Medical College, 
San Francisco. 121110. Cloth, .80 

" This is, in its way, a wonderful little book, comprising within its pages a 
more or less complete account of every part of the human body, not even omit- 
ting the histology of the tissues and organs." — Edinburgh Medical Journal. 

*' Contains many useful hints and aids to memory not found in ordinary 
works." — Canada Lancet. 

( * The arrangement is well calculated to facilitate accurate memorizing, and 
the illustrations are clear and good." — North Carolina Medical Journal. 

BRUBAKER'S Physiology. Seventh Edition, 
Enlarged and Improved. Illustrated. A Com- 
pend of Physiology, including Embryology. By 
A. P. Brubaker, m.d. ? Demonstrator of Physiology 
at Jefferson Medical College ; Professor of Physiology, 
Pennsylvania College of Dental Surgery, Philadelphia. 
28 Illustrations. i2mo. Cloth, .80 

** This is an admirable compend of physiology, including enough of anatomy 
to fit it especially for the use of students of medicine. It has been prepared by 
one who is fully fitted by his work as Demonstrator in the Jefferson Medical 
College, and as Professor of Physiology in the Pennsylvania College of Dental 
Surgery, and by his experience as quiz-master, to compile such a book, and it 
has proved its utility by the acceptance it has already found. Its style is 
clear and distinct, its teachings are sound, and it is well suited to the 
purpose for which it is intended." — Medical and Surgical Reporter. 



MATERIA MEDICA AND THERAPEUTICS. 



POTTER'S Materia Medica, Therapeutics, 
and Prescription Writing. Sixth Edition. 

Compend of Materia Medica, Therapeutics, and Pre- 
scription Writing. With special reference to the Phy- 
siological Action of Drugs. By Samuel O. L. Potter, 
m.a., m.d., m.r.c.p. (Lond.), late A. A. Surgeon, 
U. S. Army ; Professor of the Practice of Medicine, 
Cooper Medical College, San Francisco. 121110. 

Cloth, .80 



BOOKS FOR NURSES. 



HORWITZ'S Surgery. Minor Surgery and 
Bandaging. Fifth Edition. 167 Illustrations. 

A Compend of Surgery, including Minor Surgery, 
Amputations, Fractures, Dislocations, Surgical Dis- 
eases, Antiseptic Rules, Formulae, etc., with Differen- 
tial Diagnosis and Treatment, and a Complete Section 
on Bandaging. By Orville Horwitz, b.s., m.d., 
Professor of Genito-Urinary Diseases ; late Demonstra- 
tor of Surgery, Jefferson Medical College, etc. Fifth 
Edition. 324 pages. i2mo. Cloth, .80 

\* The new Section on Bandaging and Surgical Dress- 
ings consists of 34 Pages and 40 Illustrations. Every 
Bandage of any importance is Figured. 

WYTHE'S Dose and Symptom Book. The 

Physician's Pocket Dose and Symptom Book. Con- 
taining the Doses and Uses of all the Principal 
Articles of the Materia Medica, and Officinal Prepa- 
rations. By Joseph Wythe, a.m., m.d. Seventeenth 
Edition; revised and rewritten, containing Tables of 
Weights and Measures, Rules for Proportioning the 
Doses of Medicines, Hints on Treatment, etc. 
Cloth, .75; Leather, with Tucks and Pocket, $1.00 

WESTLAND. The Wife and Mother. A 

Medical Guide to the Care of her Health and the 
Management of her Children. By Albert West- 
land, m.d. i2mo. Illustrated. Cloth, $1. 50 

From the Philadelphia Medical News. 

" A noticeable point about this little volume is the commendable absence of 
technical terms, as the author plainly states that it is for the use of ' women who 
are desirous of fulfilling their proper duties of wives and mothers.' Too often, 
in works of this class, the readers for whom they are intended are confused and 
led astray by the multiplicity of words and phrases meant rather for the prac- 
titioner than the mother. . . . Altogether the books fulfills the objects for 
which it was written, and will materially assist the young married woman in 
the intelligent performance of new duties." 

From the Nurse, Boston. 

" The style is easy and fascinating. It should be in the hands of every nurse 
and married women." 



NEW EDITION. 

ACCIDENTS and EMERGENCIES. 

A Manual for the treatment of Surgical and other Injuries, 
Poisoning and various Domestic Emergencies, in the absence of the 
Physician. 



By CHARLES W. DULLES, M.D., 

Surgeon to the Out-Door Department of the University and Presbyterian 
Hospitals, Philadelphia. 



Fourth Edition, Enlarged. New Illustrations. 12mo. 

ILLUSTRATED. 

SHORT LIST OF CONTENTS. 



Cloth, $1.00 



Preliminary Remarks. 
Obstructions to Respiration. 
Foreign Bodies in the Eye, Nose and 

Ear. 
Fits or Seizures. 
Injuries to the Brain. 
Effects of Heat. 
Effects of Cold. 
Sprains. 
Dislocations. 
Fractures. 
Wounds of all kinds, including the 

bites of Dogs, Cats, Snakes, Insects, 

etc. 
Railroad and Machinery Accidents. 



Hemorrhage — Bleeding. 

Special Hemorrhages. 

Transportation of the Injured. 

Poisons and their Antidotes. 

Domestic Emergencies, includes Chol- 
era Morbus, Vomiting, Diarrhoea, 
Nervous Attacks, Earache, Tooth- 
ache, Asthmatic Attacks, Croup, 
etc., etc. 

Signs of Death. 

Supplies for Emergencies. 

The Surgical and Medicine Case, 
their contents and use, Bandaging, 
Poultices, etc. 

Index. 



*h* This book should be in the possession of every head of a 
family, Nurse, Manufacturer, Police Lieutenant, Sea Captain, Hos- 
pital Steward, School Teacher, Druggist, etc. etc. 

" Several attempts have been made to prepare a volume which would serve 
as a handy manual for reference in the time of need, in the absence of a doctor, 
but none have succeeded better than the present little work. It should be in the 
hands of all officers charged with the public conveyance of passengers, to be 
read, in preparation for emergencies, and afterward to serve as a book of refer- 
ence."— North Carolina Medical Journal. 

" This little manual contains simple directions for the preliminary treatment 
of accidents to all parts of the body and of such diseases as persons are suddenly 
seized with. Without profuseness or an unintelligible vocabulary, it contains in 
a small space a deal of useful information." — New York World. 

" This is a revised and enlarged edition, with new illustrations, of the manual, 
explaining the treatment of surgical and other injuries in the absence of the phy- 
sician. The simple and practical suggestions of this little book should be known 
to every one. Accidents are constantly occurring, and a knowledge of what 
should be done in an emergency is very valuable. Such a handbook should be 
in every home, placed where it can always be found readily. — Boston Journal 
of Education. 



" I may say that Dr. E. P. Davis' Manual has proved useful to me 
in teaching obstetrics by its clearness and its many practical sugges- 
tions."— MARION E. SMITH, Chief Nurse Philadelphia Hospital. 



DAVIS. Manual of Practical Obstetrics. By 

Edward P. Davis, a.m., m.d., Clinical Lecturer on Obstet- 
rics in the Jefferson Medical College, Professor of Obstetrics 
and Diseases of Children in the Philadelphia Polyclinic, 
Visiting Obstetrician to the Philadelphia Hospital. Second 
Edition, Enlarged. 351 pages; 150 illustrations, several 
of which are colored. Cloth, $2.00 

*' I have carefully reviewed the ' Manual of Obstetrics* by Dr. E. P. Davis. 

" It is full, accurate, concise, and gracefully and clearly written. It is a most 
excellent Manual of the art it teaches." — Prof. J. Snydam Knox, Rush 
Medical College, 222 J Calumet Avenue , Chicago. 

" I have read it with interest, and consider it one of the best works on the sub- 
ject for the use of students and practitioners. " — Dr. James P. Boyd, Albany 
Medical College, Albany, N. Y. 

" I am so well pleased with the work that I have recommended it to my class. " 
— Dr. A . L. Breysacher, Medical Department A.I. U. t Little Rock, A rk . 

" I have completed my examination of it, and want to say that I think it is 
the biggest little work on the subject it has been my privilege to look over. It 
is surely a complete work, devoid of theory, replete with practice. I heartily 
commend it as a manual. " — Dr. J. R. Rathmell, Chattanooga Medical College, 
Tenn. 

" I would say that in style and character it is abreast with the most modern 
and approved methods and thought upon the subject, that for brevity it is clear, 
systematic, and concise, very suitable for the busy student during the session at 
college, and for the busy practitioner as well. It gives the essentials, and I shall 
take pleasure in recommending it to my students. " — Dr. M. R. Mitchell, Kan- 
sas Medical College, Topeka, Kan, 

" It is especially clear and pleasing in style and the subject matter is well 
chosen. It is a good text-book. " — Dr. Clara Marshall, Philadelphia. 

" It is concise and accurate, and I cordially recommend it as admirably suited 
to the convenience of the medical student and busy practitioner. " — Dr. De 
Laskie Miller, Rush Medical College, Chicago, III. 

" I consider it a very good book. " — Prof. A. F. A. King, National Medical 
College, Columbian University, Washington, D. C. 

" I consider it a valuable work, especially for the recent graduates who are 
entering upon the practice of obstetrics and pursuing post-graduate studies. 

" I keep my copy where I can read it, and consult its pages almost daily, and 
generally find what I want in a few lines." — Dr. P. C. Clayberg, American 
Medical College, St. Louis, Mo. 

11 The book appears to me to meet the purposes for which it is written and to 
be a valuable addition to the library of the busy practitioner. " — Prof. Randolph 
Winsloiv, University of Maryland ', Balti7nore, Md. 

u I am well pleased with the 'Manual of Obstetrics' by Dr. E. P. Davis, 
and can recommend the work to the profession." — Prof. C. A. Pauly, Pulte 
Medical College, Cincinnati, O. 

" The book is a most excellent one. After careful investigation, I have no 
hesitation in cordially recommending it to anybody in need of a small manual." 
— Dr. M. D. Mann, Buffalo, N. Y. 



THE 



American Health Primers. 

EDITED BY W. W. KEEN, M.D., 

Professor of Surgery in the Jefferson Medical College, Fellow of the College 
of Physicians of Philadelphia, etc. 



12 Vols. 32mo. Attractive Cloth Binding, each 40 Cents. 

This Series of Health Primers is prepared to diffuse as widely and 
cheaply as possible, among all classes, a knowledge of the elementary facts of 
Preventive Medicine. They are intended incidentally to assist in curing dis- 
eases, and to teach, people how to form correct habits of living, and take care 
ol themselves, their children, employees, etc. 

I. HEARING AND HOW TO KEEP IT. With Illustrations. By Chas. 

H. Burnett, m.d., of Philadelphia, Aurist to the Presbyterian Hospital. 

II. LONG LIFE AND HOW TO REACH IT. By J. G Richardson, m.d., 
of Philadelphia, late Professor of Hygiene in the University of Pennsyl- 
vania. 

IIS. THE SUMMER AND ITS DISEASES. By James C. Wilson, m.d., 
of Philadelphia, Professor of the Practice of Medicine, Jefferson Medical 
College. 

IV. EYESIGHT AND HOW TO CARE FOR IT. With Illustrations. By 
George C. Harlan, m d., of Philadelphia, Surgeon to the Wills (Eye) 
Hospital. 

V. THE THROAT AND THE VOICE. With Illustrations. By J. Solis 
Cohen, m.d., of Philadelphia, Lecturer on Diseases of the Throat in Jef- 
ferson Medical College, and on the Voice in the National School of Oratory. 

VI. THE WINTER AND ITS DANGERS. By Hamilton Osgood, m.d., 
of Boston, Editorial Staff Boston Medical and Surgical Journal. 

VII. THE MOUTH AND THE TEETH. With Illustrations. By J. W. 
White, m.d., d.d.s., of Philadelphia, Editor of the Dental Cosmos. 

VIII. BRAIN WORK AND OVERWORK. By H. C. Wood, Jr., m.d., of 
Philadelphia, Clinical Professor of Nervous Diseases in the University of 
Pennsylvania. 

IX. OUR HOMES. With Illustrations. By Henry Hartshorne, m.d , 
of Philadelphia, formerly Professor of Hygiene in the University of Penn- 
sylvania. 

X. THE SKIN IN HEALTH AND DISEASE. With Illustrations. By 
L. D. Bulkley, m.d., of New York, Physician to the Skin Department 
of the New York Hospital. 

XL SEA AIR AND SEA BATHING. With Illustrations. By John H. 
Packard, m.d., of Philadelphia, Surgeon to the Pennsylvania Hospital. 

XIL SCHOOL AND INDUSTRIAL HYGIENE. By D. F. Lincoln, m.d., 
of Boston, Mass., Chairman Department of Health, American Social 
Science Association. 

" The series of 'American Health Primers ' deserves hearty commendation. 
These handbooks of practical suggestions are prepared by men whose profes- 
sional competence is beyond question, and, for the most part, by those who 
have made the subject treated the study of their lives." — New York Sun. 



THE 

Hygiene of the Nursery, 

INCLUDING THE GENERAL REGIMEN AND FEEDING OF INFANTS 

AND CHILDREN AND THE DOMESTIC MANAGEMENT 

OF THE ORDINARY EMERGENCIES OF 

EARLY LIFE. 

BY LOUIS STARR, M.D., 

Clinical Professor of Diseases of Children in the Hospital of the University 
of Pennsylvania; Physician to the Children' s Hospital, Phila. 

Fourth Edition. Enlarged and improved. 

WITH TWENTY-FIVE ILLUSTRATIONS. 
i2mo. 280 Pages. Cloth, $1.00. 



^* This book contains very complete directions for the proper 
feeding of infants: 1st, From the maternal breast. 2d. By wet- 
nurse, including rules for choosing the woman. 3d, Artificial 
Feeding. This part of the subject is elaborated carefully, so as to 
include everything of importance, and will be found of great service 
to the monthly nurse. General and specific rules for feeding are 
given, and Diet Lists from the first week up to the eighteenth 
month, with various recipes for artificial foods, peptonized milk, etc. 
Directions for the sterilization of milk, substitutes for milk, prepara- 
tion of food for both well and sick children, nutritious enemata. 
etc., and the general management of the Nursery. 

" Dr. Starr's experience as Clinical Professor of Diseases of Children in the 
University Hospital and as physician to the Children's Hospital, with his 
eminence in private practice among juvenile patients, is ample warranty for the 
satisfaction and instruction to be found in this book. The dedication " To my 
Little Patients," shows the sympathy with which the writer enters upon the 
important discussion. The volume is entirely in the modern lines of preventive 
medicine — more important in the nursery than at any other time of life ; because 
constitution building is going on then and there. In this admirable treatise, so 
clearly written that no mother need be deterred by fear of medical terms from 
making its teaching her own, Dr. Starr carries out the highest ideal of the 
modern physician, so to regulate the lives of his professional clients that the 
occasions are less frequent when he need be called in to act for serious compli- 
cations. * * * * With the numerous good treatises on the subject that 
Philadelphia publications include, this intelligent work is the most distinguished, 
as it is also the latest work on complete Hygiene of the Nursery." — The Led- 
ger, Philadelphia. 



GOULD'S POCKET MEDICAL LEXICON. 



12,000 MEDICAL WORDS 

PRONOUNCED AND DEFINED. 

A Pronouncing Lexicon of Medical Words Specially Adapted for 
Nurses, Including Many Useful Tables and a Dose List. 

BY GEORGE M. GOULD, M.D., 

Author of "An Illustrated Dictionary of Medicine, Biology , and Allied 
Sciences," " The Student' s Medical Dictionary ," etc. 

Pocket Size. 317 Pages. Gilt Edges, Full Morocco. 
Price $1.00; with a Thumb Index, $1.25. 



OVER 35,000 COPIES OF GOULD'S DICTIONARIES 
HAVE BEEN SOLD. 



'^Gould's Dictionary, Pocket Edition, is the most complete and convenient I 
have seen." — Marion E. Smith, Head Nurse, Philadelphia Hospital, Phila. 

" The Pocket Dictionary is a little gem." — L. J. Gross, Head Nurse , Buffalo 
General Hospital, 

" I have examined Gould's Dictionary, and consider it the best dictionary in 
a small compass that I have seen. The price, too, is most reasonable I shall 
recommend it to all our nurses." — F. Hutcheson, Head Nurse , Flower Mission 
Training School for Nurses, Indianapolis , Ind. 

" 1 shall certainly have the nurses each send for a copy of the dictionary. It 
is just what they need, and is a nice size to carry." — Harriet Sutherland, Head 
Nurse, Margaret Pillsbury Hospital, Concord, N. H. 



4&g=- Every nurse should have a copy of this little book in order 
to intelligently pursue her studies and to thoroughly understand 
the physician's directions. It furnishes a vast amount of informa- 
tion not to be obtained in the regular text-books. 



